Note: Descriptions are shown in the official language in which they were submitted.
2157405
PATIENT CARE AND COMMUNICATION SYSTEM
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a patient care and
communication system, more particularly, a system capable of
performing tasks such as monitoring medical equipment in
patient rooms and maintaining patient medical data;
facilitating staff-to-staff or staff-to-patient voice, visual
and data communications; and tracking the location of staff
members to provide maximum patient care.
2. Description of the Related Art
In hospital or other health care environments, the
nursing staff as well as other staff members are required to
maintain and update patient information, provide patient care,
and assist physicians in the treatment of patients. Often,
these tasks have to be performed even though there are
personnel shortages. Further, as medical technology continues
to develop to provide treatment for a greater number of medical
conditions, the volume of information that is maintained for
each patient continues to grow rapidly. As a result, stress
on the nursing staff has increased and information overload is
fast approaching.
21~7~05 lt '~
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1 To more =ully understand the above problem,
_=lacing to heath care, consider the types c= data wh=_c
art main=a=neC =Or ar: lnClV'_OUa_ ~~u~le'.'lt . ?'i~~ C..,-~ V, tn=
sta=r members need to know the patient's name and address as
well as any s~ec,~a_ wietary, environmental or physica-_ space
reauiremer~ts o= th' patient. The attending physiciar_ c.
nursing sta== may want to know the patient's conditior_,
medical history and recent v=cal sign data. I_ Lhe patient
':~as had any diagncstic tests such as x-rays or ultrasound
-_mages made aL the hospital, or aL any other hospita_, the
attending physician may want to compare these test results
with the results o' newer tests tc see how Lhe patient's
conditior_ alas progressed. In addition, __ any medicatior_
has beer_ preSCribed, tile '_'~J~?ySi.~.ian Or nursing sLa~i maV wGr_t
Lc know the idenL_Ly o~ Lhe medicatior_, when the last dose
,.
was taken and how the patient has compl,_ed w_t~: the dosage
schedule.
Current systems utilized to manage such
in~ormation includes the manua_ writing and processing c=
O the inrOrmatiOn. ~.lecLrOniC SyStemS utilized t0 prOCeSS G.?:
SLOrE'_ the in~ormatiOn 1i1V01Ve multiple computers, each
cor_iaured to process portions o~ the vast amount o=
in=ormation. ?~r~ interactive patient ass,_sLance and
meO~CaLlOn ~el_V~e?"y System ~S proposed i'_'1 Fr'Tjs:S9Gi~';~»~j ~y
7 .7
kauLmar: et a.. ~ilOt~'1er patient moriitOriT_'lg SYSt?m iS
disclosed in EF-~-0505627 by Neumann. Both systems mor_itor
patient conditions with remote processing devices.
In addition to processing the above in=ormaticr_, =he
nursing sta== attending to a number o= patient's rooms may
30 want to have some indication o= each patient's cond,_=-_on a_
nursing stations which are gar removed rrom the paL,_enc's
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bed. For example, if the patient has been admitted for a
heart condition, it would be helpful if any recent vital
signs that may indicate the onset of a heart attack could be
displayed at the nurses station when the patient presses a
call button.
Another problem faced by care givers and by
hospital administrators is determining the location of key
personnel and equipment. In an emergency or during periods
of personnel shortages, the ability to quickly locate an
0 attending physician or other staff member to provide maximum
patient care is desirable. Moreover, when special equipment
is required to treat an emergency condition or when a ward
of a hospital is experiencing personnel shortages, it is
desirable that the equipment be quickly located to reduce
~5 the time spent to locate the equipment.
One type of system utilized to locate personnel
within a hospital or other health care facility relies on
audio paging systems, sign-in and sign-out sheets and
broadcast paging systems. In a given situation, the audio
20 paging system would be tried first. This system may not be
effective if the person to be located is in an area where
the paging system is not functioning properly or has been
turned down, or if the person has left the hospital. After
an unsuccessful audio page, the sign-in and sign-out sheets
25 may be checked. If, however, the person to be located
forgot to use the sign-in sheet or sign-out sheet, critical
time may be lost in a second attempt to use the audio paging
system. In addition, a search of the sign-in and sign-out
sheets may require more time than is available in an
30 emergency situation.
When the person to be located is outside of the
hospital, broadcast paging systems are often the best way to
convey an important message. These systems require the
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individual trying to locate the person to call the paging
service, leave a message, wait for the paging service to
send the message to the individual's pocket pager and then
wait for the person being paged to call the paging service,
receive the message and respond.
Another type of currently used locator system
utilizes either radio frequency signals or infra-red signals
to communicate the position of a mobile individual or object
to a network of receivers. Once such system, the InfraCom
0 locating and signaling system available from United
Identification Systems Corp. is designed for use in a
hospital environment. Using this system, a network of
infra-red transceivers located throughout a hospital can
both transmit data to and receive data using a battery
~5 operated badge worn by hospital personnel or attached to the
equipment to be located. This badge transmits a programmed
identification signal to the network allowing the position
of the badge to be indicated on a floor plan of the
hospital.
20 Another exemplary system, the TELOC PLUS personnel
locator system available from Teloc, Inc., also uses two-way
infra-red signaling to communicate the position of a battery
powered badge in a distributed sensor network. In addition,
the Teloc system may be coupled to a private branch exchange
25 ~PBX~ to allow telephone calls from an individual to be
routed to the telephone that is closest to the badge or to
direct an intercom message to that telephone, thus providing
an alternative to an audio paging system. Each of these
systems is limited in the data that may be conveyed between
30 the stationary transceiver network and the transceiver on
the badge. In the described systems, only identification
information lend an indication that switches, which are
located on the badge, have been activated may be transmitted
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1 from the badge. Furthermore, if the transceiver on the
badge fails or is damaged, a blank badge must be programmed
to take its place. This program operation may be time
consuming, leaving the individual or the piece of equipment
invisible to the locating system for that period of time.
However, none of the above described patient
information processing systems integrate a staff locating
system with a system which facilitates audio, visual and
data communications between staff members and patients and
which maintains patient data. Accordingly, a need exists
for a patient care and communication system capable of
performing tasks such as monitoring medical equipment in
patient rooms and maintaining patient medical data,
facilitating voice, visual and data communications between
staff members and the patients, as well as a system for
tracking staff members to provide maximum patient care.
SUMMARY OF THE INVENTION
The present invention provides a patient care and
co~°unication system which comprises central processing
means for facilitating audio, visual and data communications
and a plurality of remote stations electrically connected to
the central processing means. The remote stations include
processing means for facilitating the audio, visual and data
co~unications and display means for displaying the visual
communications.
The central processing means of the present
invention facilitates the audio, visual and data
communications between the plurality of remote stations, and
includes means for determining which of the plurality of
remote stations are transmitting the audio, visual and data
communications and which of the plurality of remote stations
are to receive said audio, visual and data communications,
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and means for establishing a communication link between the
transmitting stations and the receiving stations.
Preferably, the plurality of remote stations
includes control stations, patient stations and staff
stations and the central processing means includes means for
directing said audio, visual and data signals transmitted to
said control stations to a predetermined number of said
patient stations and a predetermined number of said staff
stations.
The present invention also includes a patient care
and communication system where the plurality of remote
stations are configured and adapted for association in a
group network such that predefined audio, visual and data
signal communications are transmitted to each station in the
group. Zone controller means are provided to interface the
central processing means to the transmitting and receiving
stations.
In the preferred embodiment, the central
processing means also includes means for activating audio
co~°unication between control stations, and a predetermined
number of the patient stations and a predetermined number of
the staff stations, means for facilitating activation of a
code blue function from control stations means for
activating audio communications between the control stations
and a predetermined number of the patient stations to
facilitate audio monitoring of patient rooms from the
control stations, and means for prioritizing visual and data
communications to said control stations so as to organize
the response of staff members.
Each of the plurality of remote stations includes
means for performing diagnostic tests on peripheral
equipment connected thereto. The diagnostic tests include
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1 performing wire continuity checks and using comparators to
verify that indicator lamps are operational.
The patient stations of the system of the present
invention, include patient control means electrically
connected thereto. The patient control means, preferably,
w including means for verifying the continuity of conductors
connected between the patient stations and the patient
control means and means for controlling environmental
facilities within a patient's room.
The system of the present invention also relates
to a method of providing patient care and communication
between patient rooms and nurse stations in a health care
facility. The method includes the step of connecting a
plurality of remote stations to a central processor so as to
facilitate audio, visual and data communications
therebetween, positioning at least one of said plurality of
remote stations in each patient room located within the
health care facility, positioning at least one of said
plurality of remote stations in each nurse station of said
health care facility, attending said remote station in each
nurse station to receive said audio, visual and data signals
from said central processor and responding to said audio,
visual and data signals.
Preferably, the plurality of remote stations
include processing means for facilitating the audio, visual
and data communications and display means for displaying the
visual communications. The central processor includes means
for determining which of the plurality of remote stations
are transmitting the audio, visual and data communications
and which of the plurality of remote stations are to receive
the audio, visual and data communications, and means for
establishing a communication link between the transmitting
stations and the receiving stations.
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BRIEF DESCRIPTION OF THE DRAWINGS
The preferred embodiments of the invention are
described hereinbelow with reference to the drawings
wherein:
Figs. la and lb are respective front plan and back
plan drawings of a personal database suitable for use in the
present invention:
Fig. lc is a perspective drawing of a medicine
container;
Fig. ld is a perspective drawing of a patient
wrist band;
Fig. 2 is a perspective drawing of a portion of a
patient room which includes a patient station suitable for
use in the present invention;
15 Fig. 3 is a perspective drawing of a central nurse
station suitable for use with the present invention;
Fig. 4 is a block diagram showing the functional
connectivity of the patient station and central nurse
station shown in Figs. 2 and 3;
20 Figs. 5 through 10 are flow-chart diagrams which
illustrate the operation of the patient station shown in
Fig. 2;
Figs. lla and llb are perspective drawings of a
portable transceiver unit suitable for use with the present
25 invention;
Fig. 12 is a block diagram showing the functional
connectivity of the portable transceiver shown in Figs. lla
and llb;
Fig. 13 is a flow-chart diagram which illustrates
30 the operation of the portable transceiver unit shown in Fig.
12;
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1 Fig. 14 is a block diagram showing an exemplary
data and voice communication network suitable for use with
the present invention;
Fig. 15 is a block diagram showing details of the
transmitter-receiver units shown in Fig. 14;
Figs. 16a and 16b are flow-chart diagrams which
illustrate the operation of the transmitter receiver unit
shown in Fig. 15:
Figs. 17a and 17b are flow-chart diagrams which
illustrate the handling of patient entry and patient exit
using a hospital monitoring system that includes an
embodiment of the present invention:
Figs. 17c and 17d are flow-chart diagrams which
illustrate the use of the system as a personnel and
e~ipment locator and for handling an emergency alert
condition:
Fig. 18 is a block diagram of a system which
monitors physician services and which includes an embodiment
of the present invention;
Fig. 19 is a flow-chart diagram which illustrates
the operation of the monitoring system shown in Fig. 18;
Fig. 20a is a cut away top plan view of a drug
locker which includes an embodiment of the present
invention:
Fig. 20b is a block diagram of a drug locker
monitoring system suitable for use with the drug locker
shown in Fig. 20a:
Fig. 20c is a perspective drawing of a medication
container which may be used with the drug locker monitoring
system shown in Fig. 20b;
Fig. 20d and 20e are flow-chart diagrams which
illustrate the operation of a drug auditing system using the
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1 drug locker monitoring system shown in Fig. 20b and the
patient station in Fig. 4;
Fig. 21a is a block diagram of a student
information system which includes an embodiment of the
present invention;
Fig. 21b is a flow-chart diagram which illustrates
the operation of a student-advance electronic funds transfer
system which may be implemented on the student information
system shown in Fig. 21a;
Fig. 22 is a perspective drawing of an exemplary
base unit suitable for use with the portable transceiver
units shown in Figs. lla and llb;
Fig. 23 is a perspective drawing of a portable
nurse station suitable for use with the network shown in
15 Figs. 4 and 14;
Fig. 24 is an illustration of the components of
one embodiment of the patient care and communication system
configuration of the present invention;
Fig. 25 is a functional block diagram of an
20 alternative embodiment of a system configuration of the
present invention;
Fig. 26 is a functional block diagram of an
another alternative embodiment of a system configuration of
the present invention, illustrating grouping arrangements
25 for the stations;
Fig. 27 is a functional block diagram of an
another alternative embodiment of a system configuration of
the present invention;
Fig. 28 is a circuit block diagram for the central
30 Processing unit illustrated in Fig. 24;
Fig. 29 is flow-chart diagram for the central
processing unit illustrated in Fig. 24;
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1 Fig. 30 is a block diagram for the fail safe
feature associated with the system of the present invention;
Fig. 31 is a flow-chart diagram of the fail safe
feature illustrated in Fig. 31;
Fig. 32 is a functional block diagram of a system
configuration similar to Fig. 24, illustrating a patient
station having peripheral equipment connected thereto;
Fig. 33 is a block diagram for the nurse control
station illustrated in Fig. 24;
Fig. 34 is a circuit block diagram for the audio
circuitry of the keyboard of the nurse control station
illustrated in Fig. 24.
Figs. 35 and 36 are circuit block diagrams for the
internal circuitry for the patient stations illustrated in
Fig. 24:
Figs. 37a and 37b illustrate an exemplary flow-
chart diagram of an operation of the patient station of Fig.
24;
Fig. 38 is a flow-chart diagram associated with
the internal circuitry for the patient stations illustrated
in Fig. 24;
Figs. 39 and 40 are circuit block diagrams for the
internal circuitry for the staff stations illustrated in
Fig. 24;
Figs. 41, 42 and 43 are tables which illustrate
various call indications and associated tones generated by
the stations in response to a particular call condition;
Fig. 44 is flow-chart diagram for the central
processing unit illustrated in Fig. 35; and
Fig. 45 is a circuit diagram for the patient
control unit illustrated in Fig. 33 and showing self-test
circuitry for performing automatic continuity tests of
interconnecting wires.
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DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Generally, the patient care and communication
system of the present invention includes a communication
network that provides routine and emergency signaling to
health care facility staff members and provides high
fidelity voice communication and data transmission between
staff members in the health care facility and/or between
patients and the staff members.
The exemplary embodiments of the automatic staff
~0 locator system of the patient care and communication system
of the present invention described below, use a memory card
as a personal database. As used herein, a memory card is a
device approximately the same size and shape as an ordinary
credit card which includes a non-volatile programmable
memory. In the card used in the embodiments described
below, two types of memory are used: an electronically
erasable read only memory (EEROM) located internal to the
card and a magnetic stripe located on the surface of the
card. It is contemplated, however, that other forms of
internal memory, such as a ferro-electric RAM or a CMOS
memory with an integral battery, may be used. It is also
contemplated that the functions described below may be
implemented with other types of external memory, such as
laser card technologies which either augment or replace the
card memory.
A first embodiment of the staff locator system
described below uses the memory card to augment features
that may be provided by a transmitter, which may appear as
an identification badge. Figs. 11a and llb show typical
transmitters which are removable coupled to the memory card.
A memory card contains, for example, the name of the medical
staff worker who is to wear the badge, the individual's
authorization code, and other information. In this
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1 embodiment, the identification badge/transmitter is unable
to transmit the information contained by the memory card
unless it is effectively mated with a memory card by a base
unit, as shown in Fig. 22. In Fig. 13 the sequence of how
the identification badge transmitter transmits an
identification signal is detailed. Using these badges, a
ubiquitous network and a central computer, medical staff can
quicYly and easily be located.
Another embodiment described below involves the
use of the memory card to again be coupled with an
identification badge transmitter to continually transmit an
identification signal. A fixed receiver, responsive to the
identification signal, is installed near a secured area.
This fixed receiver has means for receiving the ID
information and automatically determining the identity of
any individual within a predetermined distance and
determining whether that individual is authorized, as shown
in the sequence of steps of Fig. 20d. This system
automatically records the identity of the person removing
the drugs and the drugs that are removed. In addition, the
system records when the drugs are administered and the
identities of the patients to whom they are given.
The memory card 110 used with these exemplary
embodiments of the invention is illustrated in Fig. la and
lb. As shown in Fig. la, the card 110 is approximately the
same size and has the same physical characteristics as an
ordinary credit card. The front of the card may include a
printed logo, 112, which identifies the provider of the
card, identifying information such as the person's name, 114
and ID number 116, as well as a legend, 118, identifying the
hospital that issued the card.
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1 The back of the card may include auxiliary,
external data storage 120 and electrical contacts 122 for
interfacing with the internal circuitry of the card. The
auxiliary data storage 120 may include magnetic stripes,
as shown in FIGURE lb, or a medium compatible with a
laser card device. The electrical contacts 122 may be in
the form of external or internal ohmic contacts, or
electromagnetic contacts, such as are disclosed in U.S.
Patent No. 4,798,322 to Bernstein et al. CARD
READER/WRITER STATION FOR USE WITH A PERSONAL MEMORY CARD
USING DIFFERENTIAL DATA TRANSFER.
An exemplary memory card, which uses ohmic
contacts and does not have any auxiliary data storage is
the memory card component of the PCMI'" system available
from PC3 Inc. This exemplary memory card includes 16,384
(16k) bytes of EEROM. The exact format of the data on
the card is unimportant for this description of the
invention since it would change with the application.
A second exemplary memory card uses only the
auxiliary data storage and has no ohmic contacts or
internal data storage. This card may be any of a number
of commercially available cards which include a magnetic
stripe.
The memory card is a portable database of
information. For purposes of this description, the card
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has two embodiments, although others are possible.
First, the card is a database containing only identifying
information about a hospital employee - a staff worker.
In this embodiment, the card will hereinafter be called a
"staff card." Second, the card is a database containing
identifying and other information about a patient at the
hospital. In this embodiment, the card will be called a
"patient card."
A patient card should include information such
as the patient's name, address and telephone number, her
age and blood group, an indication of any chronic
condition from which she suffers and any allergies that
she may have. In addition, it should indicate the name
and address of her personal physician, the date of her
most recent tetanus shot, and the identity and dosage
schedule of any prescribed medicine. For most patients,
all of this information may be recorded in 2k bytes of
storage. For cards having internal memory, this data may
be stored on the card itself. For cards having only
external memory, this data may be stored in a database
which is indexed using information stored on the card.
This data base may be located in a computer near the
patient's bed or in a centrally located main computer.
In this configuration, the patient card, like the staff
card, only includes identification information, which may
be used to access the remaining patient information from
the local or main computer.
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1 As shown in FIGURE lb, it is contemplated that
the card may also include auxiliary storage such as a
laser recording medium. This storage may be used to hold
digitally compressed radiographic images or other data
that cannot feasibly be stored in the card memory.
One useful piece of information that may be
stored in the card is a bar-code ID number. This number
is stored onto the card from a bracelet that is attached
to the patient so that it is difficult to remove. An
exemplary bracelet of this type is shown in FIGURE ld.
The bracelet 140 also includes the patient's name, 144,
and ID number 146. The bracelet is configured to be
closed, using a clamp 148, around the wrist or ankle of
the patient so that it cannot be slipped over the
patient's hand or foot, respectively. The use of the
bar-code information is described below in reference to
FIGURES 9 and 20e.
Another component of the system is a bar-code
132 that is placed on medication containers 130, as shown
in FIGURE lc. This bar-code is used, as described below
in reference to FIGURES 9 and 20e to identify medicines
to the central computer to ensure that the proper
medicine is being administered to the patient and to
audit the use of controlled substances in the hospital.
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1 FIGURES lla and llb illustrate a mobile
interface suitable for use with a staff card. This
interface includes both an infra-red (IR) transmitter and
a radio frequency transmitter which can transmit data to
a one of a group of stationary receivers or transceivers
located at various places in the hospital. Transmitters
and receivers suitable for use with the present invention
are available from Wilton Industries of Connecticut.
The database interface shown in FIGURES lla and
llb is a card holder 1111 which, when enabled by a base
unit, converts a staff card 110' into an identification
badge. The interface includes a clear plastic front
piece, 1110, which protects the memory card 110' and
through which information printed on the front of the
card may be seen. The front piece 1110 is attached to a
holder 1112 which includes all of the electronic
components of the database interface. The base includes
a fastener 1116, shown in the exemplary embodiment as a
Safety pin, which is used to attach the card holder to an
article of clothing such as the sleeve or pocket of a
nurse's uniform.
The memory card 110' is inserted into a slot
1114 in the holder 1112 to make physical contact with the
holder 1112. If a memory card 110' having internal
memory is used, it may also make electrical contact with
the holder 1112. The holder 1112 includes a push-button
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switch 1118 through which the person wearing the badge
may signal a response to the stationary system or
activate an emergency transmission mode.
When disabled, card holder 1111 cannot
cooperate with staff card 1110 to form an entity capable
of transmitting an identification signal. A base unit,
shown in Figure 22, enables card holder 1111 by reading
data from staff card 1110 and programming it to card
~0 holder 1111. This permits card holder 1111 to cooperate
with staff card 1110 to form an entity capable of
transmitting identification information.
As shown in Figure 22 base unit 2210 has a
~5 slot 2214, through which staff card 110' may be passed.
Transducers located along slot 2214 read data from staff
card 110' and writes it into memory in the card holder
1111 by means of an programming unit 2212. Unit 2212 is
located in the base unit 2210 and is electrically coupled
20 to card holder 1111 which will be next removed from the
base unit 2210.
The base unit may be rectangular in shape and
may contain one or many card holders 1111. However, only
25 one card holder at a time is programmed with the
information from a staff card 110. After card holder
1111 is programmed with the data from the staff card
110', an individual may easily remove it from base unit
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1 2210 and couple it to the card 110' by inserting the card
into the slot 1114, shown in FIGURE 11. In the exemplary
embodiment of the invention, if the card 110' is not
inserted within 45 seconds of when the holder 1111 is
removed from the base unit, the card holder will become
inactive and will, instead, emit a periodic tone pulse to
indicate that the card holder is inactive.
As shown in FIGURE 22, the base unit may also
include a key pad 2218 and screen 2220. The screen
provides instructions for the user and the keypad adds
security to the system by requesting a personal
identification number (PIN) before programming the card
holder 1111.
Prior to inserting a staff card into slot 2214,
screen 2220 reads: "Slide card through slot," or a
similar message. After sliding staff card 110 through
slot 2214, screen 2220 may prompt for a PIN. In response
to this message, the individual enters his or her
personal identification number. Only if the entered
personal identification number matches the personal
identification number stored on staff card 110 and,
optionally, in the central computer, will base unit 2210
Impart the data from the staff card to card holder 1111
and activate the holder.
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1 If the entered PIN does not match the PIN read
from the staff card, an alarm may be sounded and the
information from the card may not be programmed onto the
card holder. In this way, the likelihood that an
unauthorized person could use a stolen staff card is
decreased and the security of the apparatus is increased.
To prevent unnecessary alarms, it may be desirable to
sound the alarm only after the individual has entered an
incorrect wrong PIN a number of times in succession.
Alternatively, instead of sounding an alarm, the base
unit may be designed to automatically transfer the card
from the programming slot 2214 to a secure holding area
(not shown) when the individual has failed to provide a
correct PIN after a number of attempts.
When the programmed staff card holder 1111 is
has been mated to the staff card 110', the result is an
entity capable of continually transmitting an
identification signal. This signal is transmitted to
receiver or transceiver units located in fixed locations
each open area or room of the hospital. These units are
electronically coupled to a central computer to form a
network. Using this system, medical staff can quickly
and easily be located, as described below with reference
to FIGURE 17c.
The exemplary card holder 1111 includes an
internal switch (not shown) which is activated when the
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1 memory card 210 is inserted. Responsive to this switch,
the card holder will remain enabled for up to 9 hours
after the card is inserted. The holder will be disabled,
however, if the card is removed and, so, the switch is
5 deactivated for a period of at least 45 seconds.
Whenever the card holder 1111 is disabled, for the
reasons described above or because its internal battery
is failing, it emits a periodic tone pulse through the
speaker 1120, shown in FIGURE llb, to alert the wearer
10 that a new card holder must be obtained.
As the enabled identification badge continually
transmits the identification signal, it can be
particularly useful as a locating device. For use as a
15 locating device, the identification badge is linked by
some means to a central computer. As shown in FIGURE 4,
identification badge transmitter 1111 sends signals to a
fixed receiver or transceiver 424 which is in
communication with a central computer 432 through a
20 network server 432. This configuration is described in
more detail below. For this aspect of the invention,
however, it is only important to realize that
identification badges 1111 are in communication with the
central computer 432.
An exemplary configuration for the patient's
patient station is shown in FIGURE 2. The exemplary
patient station 210 includes a slot 216 into which the
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memory card 110, preferably a patient card, may be
inserted and a squeeze bulb 212, which, when squeezed,
alerts the duty nurse at the central nurse station that
the person in the bed needs assistance. In addition, the
patient station may include a speaker 214 through which
the duty nurse may both talk to and listen to the
patient, push button switches 218, one of which may be
used to cancel a call, a light pen 222 for reading the
bar-codes such as those on the wrist band and on the
~0 medication, one or more external data inputs 220 which
may be used to supply vital sign data to the central
nurse station.
An exemplary central nurse station 300 is
~5 illustrated in FIGURE 3. The central component of the
nurse station is a microcomputer terminal 320. This may
be, for example, a conventional IBM compatible personal
computer.
20 Data indicating, for example, which patients
have called and their relevant vital signs may be
displayed on a video screen 322 of the microcomputer 320.
Patient data, such as prescribed medication or dietary
menu choices, may be entered into the central computer
25 using the keyboard 324 of the microcomputer terminal 320.
As set forth below, this data may also be stored locally
at the patient station or, depending on the type of
memory card used, stored in the patient's memory card.
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An exemplary nurse notepad terminal is
illustrated in Figure 23. Nurse notepad 2710 includes an
internal microcomputer (not shown) and an IR transceiver
(not shown). Referring to FIGURE 4, the notepad terminal
is capable of communicating with computer 432 via the
fixed transceivers located in each room of and the
network servers 430 located in each floor or in each wing
of each floor of the hospital.
The notepad terminal 2310 includes a slot 2314
for accepting and reading a patient card 110. As patient
card 110 is slid along slot 2314, the identification and
other information is read from the card and stored in the
nurse notepad terminal. Clasp 2318 is a temporary holder
for patient card 110. Patient card 110 is kept falling
out or being confused with another by clasp 2318. Also,
clasp 2318 is configured to display the individual's name
114 on the card to an operator while the card is engaged
by notepad 2310.
As shown, notepad terminal 2310 includes a
light-pen input device 2328. A user, such as a caregiver
uses the terminal by touching the light-pen to various
icons located on screen 2324. The pen 2328 is connected
to the notepad by a cord 2332. The icons may include,
for example, various instructions, such as obtain blood
pressure, obtain time of next medication, etc. Touching
icons and selecting items from menus causes the notepad
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unit to generate messages for the central computer 432,
shown in FIGURE 4, to a patient station and/or to a
central nurse station. These messages are received for
and sent to the network via the fixed transceivers 424
v.ia the internal IR transceivers 425 of the notepad
terminal 2710.
In one embodiment, the nurse may enters various
information regarding the patient using notepad 2710.
~0 After passing patient card 110 through slot 2714, a nurse
may then input such information as age, weight, smoking
habits, blood pressure, cholesterol, etc. This
information is then communicated to central computer 432
by being transmitted from transceiver 425 to one of the
~5 fixed transceivers 424 located in each room of the
hospital and from the fixed transceivers through the
network to the network server 430 and central computer
432. The fixed transceivers 424, network servers 430 and
central computer 432 are linked in a hierarchical
20 network. In the exemplary embodiment of the invention,
this network operates according to a token-bus protocol
such that each level controls a token which is used for
communication with devices at lower levels.
25 Although Figure 23 shows a light pen for
communicating with the notepad terminal, it is
contemplated that other means such as a keypad 2334 or a
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voice recognition system (not shown) could be used to
enter information into the notepad terminal.
FIGURE 4 is a block diagram which illustrates
the functional interconnection of the various items
illustrated in FIGURES la, lb, 2, 3, and 23. As shown in
FIGURE 4, the patient station 210 includes a memory card
reader/writer, 412, into which the memory card 110 may be
inserted. The reader/writer 412, which may be, for
~0 example, the PC3t'" memory card reader/writer available
from PC3 Inc. is coupled to a patient station
microcomputer 414 by a two-way data link.
The microcomputer 414 used in the exemplary
e~odiment of the invention uses a 80C50
microcontroller, manufactured by Intel Corp. This device
includes a read only memory (ROM) program storage and
random access memory (RAM) for temporary data storage.
This internal memory may be augmented with external
memory (not shown) The nurse call button 212 is coupled
to a serial data input port of the microcomputer 414.
The light pen 222 is coupled to the microcomputer 414
through a light pen interface circuit 416. A light pen
interface circuit suitable for use in the patient station
210 is the PC E-Z-Readers'" 300/56111 model available from
PC E-Z-Reader Inc.
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1 One or more external devices, such as an
electrocardiogram, blood pressure monitor or respiration
monitor may be coupled to the microcomputer 414 through
separate external interface circuits 418. The type of
external interface circuit used depends on the type of
device which is to be monitored. If the device includes
a standard data interface, such as an RS232 port or an
IEEE 488 port, the external interface 418 may be one of
the serial interface ports to the microcomputer 414. If,
however, the external device 410 can only provide an
analog output signal, the external interface circuit 418
may include apparatus such as an analog-to-digital
converter (ADC) (not shown) to develop digital samples
representing the analog waveform.
In the exemplary embodiment of the invention,
digital samples of the data to be monitored are stored in
a circular buffer implemented in the memory of the
microcontroller 414 or in the memory card 110 itself.
The number of bytes in the buffer may be fixed at, for
example, 1024 and byte address may be generated using a
modulo 1024 counter. Thus, new data is continually
overwriting old data. In this configuration, each
circular buffer holds samples representing a fixed time
interval. If, for example, the buffer is limited to 1024
bytes and one-byte samples are added to the buffer at a
rate of 16 per second, the stored samples represent a
period of approximately one minute.
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1 Three items of information are maintained in
the fixed data portion of each circular buffer: the type
of data in the buffer, the starting address of the buffer
and the address of the oldest sample in the buffer. The
exact format of these data items depends on the number of
different types of data that may be recorded and the size
of the circular buffers.
In addition to the circuitry shown in FIGURE 4,
~0 it is contemplated that the patient station microcomputer
414 may be coupled to a keyboard (not shown) and to a
video display monitor (not shown) so that data on the
patient may be viewed from and entered into both the
central computer system 432 and the memory card 110 from
the patient's bedside.
The patient station microcomputer 414 is
coupled to the central nurse station microcomputer 420
via a network server 430. The nurse and patient stations
may be connected in a star configuration, as shown in
FIGURE 4, and/or in a ring configuration as shown in
FIGURE 14, described below. Alternatively, the patient
station and the central nurse station 300 may be coupled
through the telephone set in the patient's room. For
this type of coupling, the network interface ports in
each of the microcomputers 414 and 420 are configured to
time-division multiplex data with voice communication
when the telephone is in use. Multiple patient stations
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1 (not shown) may be coupled to the microcomputer 420 of
the nurse station 300 via the network interconnection.
The network server 430 used to couple the
patient station 210 to the central nurse station 300 may
be a complex commercially available network interface such
as that produced by Novell, Inc.
Portable nurse unit 2310, as shown in Figure 23
and Figure 4 is capable of transmitting data to a
transceiver 424. There are actually a plurality of
transceivers 424 throughout a hospital. In the exemplary
embodiment of the invention, these are infrared
transceivers capable of both transmitting and receiving
infrared signals. Such infrared transceivers are
desirably located in every open area of the hospital
because a partition or wall can easily block an infrared
signal. In general, one transceiver per room may be
sufficient; however, if a room is partitioned, then it
may be desirable to place one transceiver 424 in each
open area of the room to easily receive the infrared
transmission from external devices or nurse notepad
terminals.
Transceiver 424 is in electrical communication
with server 430, as shown in Figure 4. All of servers
430 are connected, for example, in a star configuration
and linked to central computing system 432.
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1 Similarly, patient station microcomputer 414
and nurse station microcomputer 420 are linked to server
430. The patient station microcomputer 414 could either
be linked by a cable or could be linked via infrared
transceivers 452 and 456 in the same way that portable
nurse unit 2310 is linked via transceivers 425 and 424.
The IR transceivers 424 also provide network
connections for stand-alone external devices which may be
~~ used to send data on patient vital signs to the computer
network and for the staff badge transmitter 1111,
described above.
FIGURE 5 is a flow-chart diagram which
illustrates the main loop of the program that controls
the patient station 210. At step 510, the microcomputer
414 in the patient station 210 is in an idle state
waiting for an interrupt. In this state, the
microcomputer 414 may be used for other purposes, such as
to provide the patient with information or entertainment.
Alternatively, the microcomputer 414 may be programmed
with diagnostic aids for use by the caregivers in
monitoring the patient's condition.
When an interrupt occurs, the computer 414
enters an interrupt routine which checks for the
occurrence of each possible type of interrupt, processes
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the interrupts which have been provided to the routine
and returns the microcomputer 414 to its idle state.
At step 512, the interrupt routine determines
if the interrupt was generated by the patient squeezing
the bulb 212 or by pressing the nurse call button. If
so, the step 514 is executed which performs the call
nurse station function and control is transferred to step
516. The steps which implement the call nurse station
~0 function are described below with reference to FIGURE 6.
After the nurse call interrupt is processed at
step 514 or if the interrupt was not a nurse call at step
512, the interrupt routine, at step 516, determines if
5 the interrupt was caused by data being provided to the
microcomputer 414 from the central nurse station 300. If
so, step 516 invokes step 518 to store the data provided
from the nurse station 300 into the local memory of the
patient station or, if appropriate, into the memory card
20 110 itself. Step 518 and then transfers control to step
520. The steps which implement the step 518 are
described below in reference to FIGURE 7.
If, at step 516, it is determined that the
25 interrupt was not caused by the receipt of data from the
nurse station 300, control is transferred to step 520.
Step 520 determines if the interrupt was generated by an
external device, coupled to the external device input
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1 port 220 (shown in FIGURE 2). As set forth above, one or
more external devices may be coupled to the patient
station 210 to store a vital sign data in its local
memory or on the memory card 110. The interrupt detected
at step 520 would occur when one of these external
devices is ready to provide a sample to the patient
station 210.
If step 520 determines that the interrupt is
~0 from an external device, step 522 is executed to store
the external data onto the card and then control is
passed to step 524. The process represented by step 522
is described below with reference to FIGURE 8.
If, at step 520, it is determined that the
interrupt was not generated by an external device,
control is transferred to step 524. Step 524 is executed
to determine if the interrupt was generated by the light
pen 222. As set forth above, the light pen 222 is
Provided to read bar-coded information from patient wrist
bands, containers of prescription medicine, food trays,
diagnostic images and other material that is desirably
associated with a particular patient. The light pen 222
may be operated, for example, by pressing a button on the
Pen while the pen is dragged across the bar code and then
releasing the button. the light pen interrupt would be
generated when the button is released. If a light pen
interrupt is detected at step 524, the interrupt routine
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invokes step 526 to process the light pen interrupt and
then transfers control to step 528. The steps performed
in carrying out step 526 are described below with
reference to FIGURE 9.
If, at step 524, it is determined that the
interrupt was not generated by the light pen 222, control
is transferred to step 528. Step 528 determines if the
interrupt was caused by the internal timer of the
0 microcomputer 414. If so, step 528 invokes a step 530 to
process the internal timer interrupt. This step acts as
an alarm clock to ensure that medication is administered
on time and to ensure that any data which needs to be
monitored at timed intervals is handled properly. When
the internal timer has been processed, step 530 transfers
control to step 510 to wait for the next interrupt.
Control is also transferred to step 510 from step 528 if
it is determined that no internal timer interrupt needs
to be serviced.
In this description of the exemplary
embodiments of the invention, reference is made to
storing data into the card. If either of the memory
cards 110 and 110' has limited or external memory or has
internal memory which can undergo only a limited number
of storage operations, it may be desirable to assign a
buffer area in any of the microcomputers or
microcontrollers coupled to the data card which acts as
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the card memory while the card is coupled to the device.
In this instance a write operation to memory locations on
the card would only be made when the card is removed from
the device. At this time, the contents of the buffer may
be transferred to the memory card as a block or separate
write operations may be performed for those locations
that have been changed while the card has been attached
to the device.
FIGURE 6 is a flow-chart diagram showing
details of the processing steps performed by the
processor 414 in response to a nurse call interrupt.
Steps 610, 612 and 614 read fixed data from the patient
station 210 as shown in FIGURE 2. This data is stored in
the local memory of the computer 414. At step 616, the
microcomputer 414 determines if an external device is
coupled to the external device input port 220, if the
patient station 210 has been enabled to receive data from
the device and if the device has written any data to the
Patient station memory. If all of these conditions are
met, step 616 transfers control to step 618. The
microcomputer 414, at step 618, determines the location
of the data to be read and the address of the oldest
sample.
30
After step 618, or if one of the conditions
fails at step 616, control is transferred to step 620.
This step formats the data that is to be transferred to
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1 the nurse station 300 and transmits it to the nurse
station via the network server 430.
At step 622, the microcomputer 414 waits for an
acknowledge (ACK) response from the microcomputer 420.
If a negative acknowledge (NAK) is received or if there
is no response after a predetermined time-out period, the
computer 414 transfers control back to step 610 and the
process of extracting, formatting and transmitting the
data is repeated. If the ACK is received at step 622,
the call nurse station process terminates at step 624.
The nurse call message remains active at the nurse
station 300 until it is cleared by pressing the CLEAR
button 218 of the patient station 210, as shown in FIGURE
2'
FIGURE 7 illustrates the program flow of the
process which stores data onto the memory card or into
the memory card buffer area of the microcomputer 414.
This process is step 518 of FIGURE 5. The first step in
the process, step 710, determines if the data being
entered is medication data. If so, at step 712, the
process calculates the time for the next dose and sets
the interval timer.
30
After step 712 or if the data is not medication
data at step 710, the process executes step 714, which
calculates a checksum of the data and the address at
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1 which the data is to be stored. At step 716, the data
and the checksum are then supplied to the memory card
buffer area or to the memory card reader/writer 412. The
data is provided with the starting address on the card of
the first storage location to be used to hold the data.
Step 716 also conditions the reader/writer 412 to write
the data onto the card.
At step 718, the microcomputer 414 conditions
~0 to read the data that was just written to the card or to
the card buffer area and calculates a checksum for the
data and address value. Step 720 compares the checksum
calculated for the original data to the checksum
calculated for the retrieved data. If the checksums are
not equal, the microcomputer, at step 722, sends an error
message to the nurse station microcomputer 420 and
transfers control to step 714 to retry the data storage
operation. If, at step 720, the checksums are found to
be equal, the data storage process terminates at step
724.
FIGURE 8 is a flow-chart diagram of the process
522 of FIGURE 5, which stores data from external devices
into the local memory of the patient station
microcomputer 414. The first step in the process, 810,
reads the next data address into which data is to be
written from the card buffer area in the microcomputer
414. This address is the same as the address of the
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oldest data item. Step 812, stores one byte of data into
this address and calculates the next address. As set
forth above, the address calculation uses the length of
the buffer as a modulus so that the buffer appears to be
a circular buffer. For example, if a buffer length of
1024 is selected and the base address of the data in the
local memory of the microcomputer 414 is at BASEADR, the
address calculation to obtain the next address, NXADR
from the current address, CURADR may be calculated using
0 the equation (1).
NXADF = BASEADR + (CURADR - BASEADR + 1) modulo 1024 (1)
At step 814, the microcomputer 414 determines
if the data item just stored was the last data item to be
processed. If so, step 816 is executed in which the
microcomputer 414 stores the calculated next address
value in the memory card buffer area as the address of
the oldest data item. Step 816 then ends the external
data storage process. Otherwise, step 814 transfers
control to step 812 to write the next data item onto the
designated card buffer area.
In the same way that external data is stored
from patient station microcomputer 414, data can be
stored from portable nurse unit 2310. Such data could be
entered from an external device with a transceiver 411.
This information is communicated to the portable nurse
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unit then sent by transceivers 425 and 424 to server 430.
The information could either be stored at server 430 or
server 430 could be configured to send a signal back
through transceivers 424 and 425 to the portable nurse
unit 2310 instructing the nurse unit to impart the
information onto the memory card which is loaded onto the
portable nurse unit.
FIGURE 9 illustrates the steps performed by the
~0 microcomputer 414 in processing data from the light pen
222 of FIGURE 2. In the exemplary embodiment of the
invention, the light pen data is provided to the
microcomputer 414 via the light pen interface 416, shown
in FIGURE 4. This interface translates the alternating
light and dark patterns sensed by the light pen 222 into
a sequence of digits. Conventional bar-coded data
includes a check digit, such as a cyclic redundancy code
(CRC) digit, as the last digit of the data. This digit
may be calculated by applying a predetermined formula to
the other bar-coded digits.
In the exemplary embodiment of the invention,
bar-codes are used to ensure that medications,
radiographic images, food trays and other material are
Provided to the proper patient. As an example of how the
bar-codes may be used for this function, consider the
administration of prescribed medication. Before giving
the medication to the patient, the nurse first scans the
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patient arm band. The patient station compares the
scanned data to the identification data received from
the card. If these two codes do not match then either
the patient is in the wrong bed or the wrong memory card
is inserted in the patient station 210.
If the codes do match, the nurse then scans the
bar-code on the medication container. The patient
station 210 compares the scanned data to medication data
in the memory card buffer area. If a match is found, the
station 210 determines when the next dose of the medicine
is to be administered. If the next dose is past due or
if it is due in the near future, the patient station 210
records a the time at which the medication was given. If
the medication is not found in the card buffer area or if
it is not yet due, the station 210 sounds an alarm, for
example a distinctive series of pulse tones, and sends an
appropriate error message to the nurse station 300. If,
as set forth above, the patient station 210 is equipped
with a display device, the error message may also be
displayed on the patient station display.
For radiographic images, food trays and other
material that is simply to be delivered to the patient s
bed, a bar-code identifying the patient is scanned from
the image, tray or other material. The scanned data is
then compared to the identifying data on the card. If
the data is correct, the scan is acknowledged with a
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1 beep. Otherwise the alarm is sounded and an error
message is sent to the nurse station 300 indicating that
material has been delivered to the wrong patient.
The first step in FIGURE 9, step 910,
calculates the check digit using all but the last digit
of the code supplied by the light pen interface 416.
Step 912 then compares the calculated check digit to the
last digit of the scanned code. If the digits do not
match, step 914 is executed which returns control to the
main loop program shown in FIGURE 5.
If, however, the check digit is found to be
valid at step 912, step 916 is executed which
acknowledges the receipt of the code by conditioning the
patient station 210 to emit a beep from its speaker 214.
At step 918, the microcomputer 414 determines if the code
provided by the light pen interface 416 is identification
data. If so, step 920 is executed to determine if the
supplied code matches the code stored on the card buffer
area. As set forth above, this codes was entered into the
buffer area from the card. The data on the card was
entered by scanning the patient's arm band during
admission processing. If the scanned identification code
matches the stored code at step 920, step 922 is executed
which resets the error flag and returns control to the
main program loop.
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1 Otherwise, step 934 is executed. This step
sounds an alarm through the speaker 214 of the patient
station 210, sets the error flag and sends an error
message to the central nurse station 300 indicating that
the scanned identification data does not match the stored
data.
If, at step 918, the scanned data is not
identification data, step 924 is executed. Step 924
determines if the scanned data is medication data. If
so, 926 is executed, otherwise, an error has occurred and
control is transferred to step 934. This step operates
in the same manner as set forth above, except that the
error message indicates that the scanned data was neither
identification data nor medication data.
Step 926 determines if the scanned medication
matches any of the medication data stored in the memory
card buffer area. If a match is found, step 928 is
executed, otherwise an error has occurred and step 934 is
executed with an error message indicating that the
medication has not been prescribed for the patient.
In step 928, the microcomputer 414 compares the
current time, as derived from its internal time of day
clock, to the stored time for the next dose of the
medication. This time value is stored in the card buffer
area as a part of a multi-value record for the medication
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information. Each prescribed medication is entered in
the buffer area as a separate medication record. If the
next dose time has passed or if it is in the near future,
for example, 15 minutes from the present, step 930 is
executed. Otherwise, an error has occurred and step 934
is executed with an error message indicating that the
medication is being provided at the wrong time.
Step 930 checks the error flag. This flag is
~0 set in step 934 if any error occurs and is reset in step
922 when the scanned identification data is found to
match the patient. The test in 930 ensures that
erroneous identification data is not ignored. If the
error flag is set at step 930, then an error that
occurred during a previous attempt to administer
medication has not been cleared. In this instance, step
934 is executed with an error message indicating that a
previous error has not been cleared.
If, at step 930, the error flag is reset, step
932 is executed. This step conditions the patient
station 210 to emit an acknowledging beep, disables any
internal timer interrupt that may be set for this
medication dose, records the current time in the
medication record to indicate that the medication has
been administered and calculates the time for the next
dose. The next-dose time is also stored in the
medication record on the memory card buffer area of the
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microcomputer 414 and an internal timer interrupt is set
for this next dose time. After step 932 and after step
934, the process which reads the light pen data is
complete and control is returned to the main loop program
at step 936.
In the same way as shown in Figure 9, portable
reader 2310, as shown in Figure 23 and at Figure 4, can
be used in place of the combination of light pen and
Patient station microcomputer to determine when the next
dose of a prescription drug is due. Portable reader 2310
has a slot, 2314, for accepting and scanning and reading
the information from a patient memory card. It also can
read a bar code on a patient's wrist or a medication
bottle using a light pen 2328. Portable reader 2310 also
is capable of transmitting input of this information to a
fixed transceiver such as transceiver 424 as shown in
Figure 4. This information is then sent to server 430
via transceiver 425. The portable reader 2310 operates
in the same manner as the patient station as illustrated
by FIGURE 9.
FIGURE 10 illustrates the program flow of step
530 of FIGURE 5, which processes the internal timer
interrupts from the microcomputer 414 of the patient
station. In the exemplary embodiment of the invention,
the timed event, for example, the next-dose time in a
medication record, is stored in the card buffer area at a
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1 known location. Step 1010 reads the event data from the
buffer area, using the address that was stored with the
timer interrupt request. Step 1012 compares the stored
time to the current time and checks an alarm cleared flag
to detenaine if the alarm is no longer necessary. If
step 1012 determines that the alarm has been cleared,
control is returned, at step 1014, to the main program
loop of FIGURE 5.
If the alarm has not been cleared at step 1012,
step 1016 is executed to determine if the patient is to
be alerted or if only the nurse station 300 is to be
alerted. If the patient is to be alerted, step 1018 is
executed which conditions the patient station 210 to emit
an audible alarm through the speaker 214. Whether or not
the patient is to be alerted, step 1020 is executed to
send an alarm message to the nurse station 300. In the
exemplary embodiment of the invention, the text of the
alar~a message is determined from a code stored with the
timer interrupt data on the memory card 110. This code
is used to index a table of alarm messages stored in
read-only memory (ROM) (not shown) in the patient station
microcomputer 414.
After step 1020, the microcomputer 414 executes
step 1022 to set a reminder alarm for a predetermined
time, for example, five minutes after the initial alarm.
This reminder alarm is handled in the same manner as any
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1 other internal timer interrupt. Any outstanding reminder
alarms may be cleared by pressing the CLEAR button 218 on
the patient station 210.
The discussion above has centered on the use of
the invention for patients in a hospital. Since a
hospital patient spends a large percentage of time in his
bed, the interface between the personal database and the
hospital compute system can be a fixture in the
0 patient's room. For reasons set forth below, it is
desirable to extend the use of the invention to
caregivers at the hospital. Caregivers, however, are
more mobile and would not be adequately served by an
immobile interface.
FIGURE 12 is a block diagram that illustrates
the functional structure of the electronic circuitry in
the base 1112 of the badge-holder database interface.
For the sake of simplicity, the power supply has been
omitted from FIGURE 12. In the exemplary embodiment,
power is provided by a standard replaceable lithium
battery (not shown). The microcomputer 1214 may be any
one of a number of commercially available
microcontrollers, such as the 80C49 manufactured by Intel
Corporation, coupled to ROM program storage (not shown)
and RAM data storage (not shown).
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The badge transmitter includes an infrared
transmitter 1224, a radio frequency transmitter 1225 and
an audio tone generator 1220. Badges which are able to
both send and receive data and to store data into a
programmable memory card also include an infrared
receiver 1210 and a memory card interface 1216.
In a badge transceiver of this type, the
functions performed by the microcomputer 1214 may include
~0 providing an address to a memory card interface 1216 to
store data into or read data from the memory card 110,
conditioning an audio tone generator 1220 to produce an
audio signal from the speaker 1120, or storing a value
into one of the registers 1222I and 12228 and then
~5 conditioning the appropriate transmitter 1224 or 1225 to
broadcast the data value to the network of fixed infrared
and RF transceivers.
Alternatively, when the badge transmitter is a
20 simple transponder which emits an identification code at
predetermined intervals as programmed by the base unit,
the microcomputer 1214 may be eliminated and replaced by
a programmable timer and/or simple logic circuitry to
perform the limited functions of the transponding badge.
30
Also included in the badge circuitry is the
push-button switch 1118, through which a source of logic-
one value, 1217, may be momentarily coupled to an
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1 interrupt line, BI, of the microcomputer 1214. In
response to this interrupt, the microcomputer 1214 sends
identifying information, read from the memory card 110
and either an emergency alert message or an acknowledge
message using both the infrared transmitter 1224 and the
radio frequency transmitter 1225. The operation of the
circuitry shown in FIGURE 12 in the hospital environment
is described below with reference to FIGURES 13-16.
In the exemplary embodiment, the badge holder
includes two transmitters, an infrared transmitter 1224
which is used primarily to send identification data and a
radio-frequency device, operating at frequencies of
approximately 300 MHz. Radio frequency transmitters
suitable for use in the badge holder are available from
Dallas Semiconductor Inc. It is contemplated that other
transmitter components may be used, for example, the
infrared transmitter of the PLS-4000 personnel locating
system available from TELOC, Inc.
Figure 13 is a flow-chart diagram which
illustrates the operation of the badge transmitter shown
in FIGURES 11 and 12. The badge transmitter is activated
by an interrupt at step 1310. The interrupt may be from
the push-button switch 1118 or from an internal timer
(not shown) which is set by the base unit 2210, shown in
FIGURE 22, to periodically transmit the identification
information. If, at step 1312, it is determined that the
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interrupt was generated by the switch 1118, the
microcomputer 1214, at step 1314, conditions the audio
generator 1220 to provide a pulse tone signal to the
speaker 1120. This tone serves as audio feedback letting
the wearer know that the badge circuitry has sensed the
closing of the switch 1118.
When the button 1118 is pushed, the wearer is
assumed to be signalling an emergency alert. In this
~0 instance step 1320 is executed which conditions the
microcomputer 1214 to send an emergency alert message to
the transmit registers 1222I and 12228 and to transmit
the message through both the IR transmitter 1224 and the
RF transmitter 1225. In order to reduce the number of
accidental emergency alert messages, it may be desirable
to program the microcomputer 1214 to require that the
switch 1118 be pressed in a pattern, for example, three
times within a 10 second interval to signal an emergency
alert. After the message is transmitted in step 1320,
control is transferred to step 1310 to await the next
interrupt. If the host computer is waiting for an
acknowledgement from the badge wearer, this message is
interpreted as an acknowledgement. Alternatively it may
be desirable to have another code, for example, pressing
the switch once or twice to indicate an acknowledgement.
If, at step 1312, the interrupt is a timer
interrupt, a signal which includes a synchronization
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1 component and an identification component is transmitted
in a discrete time interval, for example 45 microseconds,
at a preset time interval having a maximum length of, for
example 3 seconds. As set forth above, this time
interval is assigned by the base unit 2210 when the badge
holder 1111 is programmed.
At step 1346, the identification data and a
check sum are generated by the microcomputer 1214 and, at
step 1349, are loaded into the IR transmission register
1222I. Also at step 1349, the IR transmitter 1224 is
activated to transmit the data. At step 1350, the badge
transmitter returns to an idle state to await the next
interrupt.
The timer, which is programmed by the base unit
2210, repeatedly interrupts the badge unit at a fixed
time interval which is different for each badge unit.
Since an individual transmission occupies only 45
microseconds out of a three-second interval, as many as
65,536 (2'6) such intervals may be defined. This
continual transmission of relatively short identification
signals permits a relatively large number of entities
within one communication network while keeping the
likelihood of conflicts caused by overlapping message
transmissions low.
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1 As set forth above, the badge transmitter is
used, in this embodiment of the invention may be used as
a data link between the personal database implemented in
the memory card 110' and the central computer system.
The portable nurse station 2310 and external devices,
such as device 428 of FIGURE 4 may also be coupled to the
central computer via a wireless data link. The other
part of this data link is the network of stationary
transmitters located at fixed positions around the
hospital. FIGURE 4 is a block diagram showing the data
link between the network of stationary transceivers, the
nurse stations, the patient stations and the central
computer system 432.
As shown in FIGURE 14, the stationary
transceivers 1402 and 1404; the nurse stations 1406, 1408
and 1410: and the patient stations 1412 through 1428 are
all coupled to the network server 430 via a star-type
network N2. In addition, the nurse stations 1406, 1408
and 1410 are coupled together by a ring network N1. In
the event of a failure of the central computer 432 or
network server 430, data communications among the central
nurse stations would occur through the network Nl.
In the exemplary embodiment of the invention,
each of the stationary transceivers 1402 and 1404 is
responsive to commands from the central computer 432,
transmitted via the network server 430, to receive
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identification data from (and optionally transmit data
to) the various badge transceivers, to receive telemetry
data from external devices such as the device 428 of
FIGURE 4 and to receive data from the transmit data to
the portable nurse stations such as the station 2310 of
FIGURE 4. Each stationary transceiver includes circuitry
which automatically performs all of the steps needed to
ensure that the command from the main computer is carried
out and that the data was delivered without corruption.
FIGURE 5 is a block diagram showing the
functional structure of a stationary transceiver. In
addition to an infrared transmitter 1514, an infrared
receiver 1516 and an RF receiver 1515, the transceiver
includes a microcontroller 1512 and a digital data
interface 1510 through which the transceiver is coupled
to the server 430. The network digital data interface
1510 provides a digital data connection to the server
430. The type of unit used depends on the network
connectivity available to the server.
The stationary transceiver shown in FIGURE 15
includes a microcontroller 1512. This unit includes a
simple microprocessor (not shown), a ROM program store
(not shown) and a small RAM (not shown) for holding data
and temporary results. The microcontroller 1512 is
programmed to implement a low-level portion of a
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hierarchical token bus protocol. It supplies a token to
one of
FIGURE 16a is a flow-chart diagram which
illustrates the process steps performed by the program
that controls the microcontroller 1512. As set forth
above, the stationary transceivers 1418, 1422 and 1428
are programmed to carry out commands provided by the
central computer system. These commands include: a
~0 status request command for which the stationary
transceiver sends an indication of its status to the main
computer, a transmit data command for which the
stationary transceiver transmits data provided with the
command, and a receive data command for which the
stationary transceiver expects to receive data from a
portable nurse station, external monitoring device or,
optionally, a badge transceiver. Multiple commands may
be issued at a single time.
At step 1604 of the stationary transceiver
process, as shown in FIGURE 16a, the transceiver waits
for an interrupt. When an interrupt occurs, it may be
from the infrared or RF receiver or it may be from the
central computer 432 via the network server 430.
Interrupts from the infrared or RF receivers may occur at
any time. As set forth above, the interrupts may
signal the receipt of an identification message sent by a
transponder badge or an emergency alter message caused by
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pressing the emergency alert button on the badge. If, at
step 1606, the message is from the IR or RF receiver,
step 1608 is executed to format the message and send it
to the network server 430. After step 1608, control is
returned to step 1604 to await the next interrupt.
Alternatively, if, at step 1606, a message from
the network interface is detected, step 1610 is executed.
At step 1610, the command message is received from the
0 central computer 432 via the data communications network
N2 and the network interface 1510 and the number of
commands in the message is stored in a memory location
COMMAND COUNT. This memory location serves as a pointer
to the commands in the message.
Step 1609 determines if any commands in the
message have not been executed. If unexecuted commands
exist, then at step 1611, the next command is selected
from the message. At step 1612, the microcontroller 1512
determines if this command is a status request command.
If so, step 1614 is executed. This step sends a status
message to the central computer 432 and decrements
COMMAND COUNT so that it points to the next command. The
status message may include, for example, information
identifying the stationary transceiver and its location,
and the numbers of ACK and NAK messages both sent and
received by the stationary transceiver. The relative
numbers of ACK and NAK messages provide an indication of
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1 the condition of the stationary transceiver. After step
1614 control is transferred to step 1609 to extract the
next command from the received message.
If, at step 1614, the selected command is not a
status request, then step 1616 is executed. This step
determines if the command is a transmit data command. If
so, at step 1618, the data to be transmitted is sent to
the infrared transmitter 1514 and the transmitter is
conditioned to broadcast the data. At step 1620, the
microcontroller 1512 waits two seconds for an ACK message
from the receiving transceiver (e.g. the transceiver of a
portable nurse station 2310 or external device 428, shown
in FIGURE 4) indicating that the message has been
received.
If, at step 1622, an ACK is received during the
two second interval, the microcontroller 1512, at step
1624, sends an ACK message to the central computer 432,
decrements the COI~iAND COUNT to point to the next command
and transfers control to step 1609 to retrieve the next
command from the message. Otherwise, at step 1626, the
microcontroller 1512 sends a NAK message to the central
computer and branches to step 1609 to retry the current
command. In this embodiment of the invention, the
central computer 432 is programmed to allow a fixed
number of retries (consecutive NAK messages) and then to
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retransmit the command message to the stationary
transceiver.
At step 1616, if the selected command is not a
transmit data command, step 1620 is executed to determine
if it is a receive data command. If so, the
microcontroller 1512 sends a read data message to the
transmitter 1514 and conditions the transmitter to
broadcast the message. Step 1630 then transfers control
0 to step 1620, described above.
Steps 1620, 1622, 1624 and 1626 operate in the
same manner for the receive data message as for the
transmit data message except that step 1624 sends the
data to the central computer 432 via the network server
430 and an ACK message to the other transceivers, while
step 1626 sends NAK messages to both the other
transceivers and the central computer 432. The
microcontroller 1512 does not check for parity errors or
checksum errors in the received data. These checks are
performed at the central computer when it receives the
data.
If, at step 1628, the command is not a receive
data command, then it is an unknown command. In this
instance, the microcontroller 1512 sends a NAK message to
the central computer 432, decrements the command count
and then branches to step 1609 to get the next command.
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The process illustrated in FIGURE 16a runs on
the microcontroller 1512 in a continuous loop. This
process is continually interrupted by a signal received
from one of the badge transmitters which continually
transmit their identification signals. Emergency alert
messages or response messages generated by pressing the
button 1118 on the badge transmitter 1111, shown in
FIGURE 11, occur only occasionally and should not be able
to be confused with any other data messages. Thus, the
~0 microcontroller 1512 includes an unmaskable interrupt
which is caused when the RF receiver receives a message.
In this instance, at step 1650 of FIGURE 16b, the
interrupt is sensed and in response to this interrupt, at
step 1656, the identification information from the badge
and the location of the fixed transceiver which received
the information are sent to the central computer 432.
The discussion of FIGURES 1-16b above has
described various components of a distributed processing
network in which information on individuals and important
equipment is stored on a personal database that is kept
in close proximity to the individual or equipment.
FIGURES 17a through 17d illustrate four exemplary
functions that may be performed using this network.
FIGURES 17a and 17b describe steps performed when the
patient enters and leaves the hospital. FIGURE 17c
describes a process for locating equipment and personnel,
and FIGURE 17d describes a process for automating the
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1 assembly of teams of specialists to handle an emergency
situation such as a "code blue."
At step 1710 of FIGURE 17a, when a patient
enters the hospital he may already have been issued a
memory card 110. If so, at step 1712, he may have the
card in his possession, in which case he presents it, or
he may not have the card. If he does not have the card,
step 1714 is executed which transfers an image of the
card data as of the time the patient left the hospital,
onto a new card. This stored data may be maintained in
auxiliary data storage, such as a cartridge tape, coupled
to the central computer 432. If, at step 1710, the
patient has not been assigned a card, he is interviewed
and, at 1716, the data from the interview is formatted
and stored on a memory card. At step 1718, data on the
card is printed so that the patient may examine and
correct it. If any corrections are needed, step 1718
branches to step 1716 to enter the corrections.
After step 1718, when the patient has a card
and the data on the card is correct, step 1720 is
executed. In this step, an identifying wrist band, such
as the band 140 described above in reference to FIGURE
ld, is physically attached to the patient and the bar-
code on the band is read and stored in the memory card.
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When the patient is taken to his room, the card
is inserted into the patient station 210 as set forth
above in reference to FIGURE 2 and the identification and
other data is read from the card and stored locally in
the card buffer area of the patient station, 210. If the
card is removed, the data in this buffer is automatically
invalidated and must be read from the card again.
Accordingly, if the memory card 110 is a magnetic stripe
card, data in the buffer is desirably written onto the
~0 card before it is removed. This may be accomplished, for
example, by requiring a button on the patient station to
be pressed before the card may be removed. This button
invokes a routine in the patient station microcomputer
414 which transfers the contents of the card buffer onto
the card and then signals, for example, by causing a
light to blink, that the card may be removed.
When the patient's food trays are prepared in
the hospital kitchen, the central computer 432 is first
checked to determine if the patient is still in his room
(i.e. if his card is still engaged) and if his diet has
been changed. This information is obtained directly from
the patent station 210. When the tray is prepared, a
sticker containing the patient's bar-code identification
information and room number is attached to the tray.
When the orderly delivers the tray, he scans the bar-code
on the patient's wrist and the bar-code on the tray using
the light pen at the patient station located near the
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1 patient's bed. If the bar-codes match, the patient
station 210 emits an acknowledging beep and notifies the
central computer that the tray has been delivered. If
the bar-codes do not match, the patient station 210 emits
an alarm tone. In this instance, the orderly may take
the tray to the closest nurse station to determine what
type of error occurred and how it may be corrected.
Alternatively, this check could be performed by the
orderly using a portable nurse station 2310 shown in
FIGURES 4 and 23. The same procedure could be used to
deliver radiographic images or medical test results to a
patient's bedside.
Alternatively, if the patent card 110 has only
limited memory storage capability, it may contain only
the patient identification data and the data from the
interview could be stored directly in central computer
432. In operation, when patient memory card is linked to
a portable nurse unit or a patient station, this
identification data is read from the card and transmitted
via an infrared transmitter or other network link to a
central nurse station and then to the server 430 and
central computer 432. From this identification data, the
already entered data could be downloaded temporarily to
the sending unit and only maintained while memory card is
coupled to the unit. Upon removal of the patient memory
card from the particular unit being used, the downloaded
patient information is desirably invalidated.
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In FIGURE 17b, when a patient leaves the
hospital, he presents his card at the administration desk
and the card is coupled to the central computer 432
which, at step 1730, records the exit time and generates
billing information. At steps 1732 and 1734, the central
computer notifies housekeeping and the hospital kitchen
to prepare the bed for the next patient and to make no
more food trays for the patient. Step 1736 checks for
any equipment that was assigned to the patient and marks
~0 the equipment as being available in a central database.
FIGURE 17c illustrates how the memory cards 110
and 110' may be used in an automatic locator system.
This is an automatic system because the identification
badge continually transmits an identification signal and
the central computer is continually monitoring these
signals to update the location of the badge. Thus, this
locator system does not require the computer to process a
particular request before it locates an individual.
Referring to FIGURE 17c, at step 1750 a user
identifies the person or piece of equipment to be located
to the central computer 432. At step 1752, the central
computer searches the database for the entered name and
finds the corresponding ID number.
As a continuing process, each of the stationary
transceivers waits, at step 1751, to receive a locator
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1 message. When a person wearing a staff badge enters a
room, the fixed transceiver in the room receives the
transmitted ID number in a locator message and, at step
1753, sends the received ID number together with an
address for the remote transceiver to the central
computer 432. Patient identifiers and room numbers are
sent to the central computer only when they are changed.
That is to say when a patient card is either inserted
into or removed from a patient station.
At step 1754, the central computer periodically
receives messages from all of the fixed transceivers and
from any of the patient stations which may have changed.
At step 1755 it updates the entries in the data base to
reflect the new~location for each received ID number.
Each location entry overwrites a previous entry and is
marked with a timestamp. The two most recent locations
are kept for each individual in the database. Using the
two entries and their timestamps, the locator system can
provide not only the location of the individual but his
or her direction of travel as well.
At step 1756, the central computer determines
if the ID number corresponding to the requested person or
piece of equipment is in the database. If it is not, the
central computer displays a message on the user's display
terminal indicating that the requested entity is not
present in the hospital.
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If the ID number is in the database, the
central computer, at step 1758 determines if the location
entry is current. If not, that is to say if the
timestamp is more than, for example, five minutes old,
the central computer, at step 1760, displays a message
indicating that the requested entity has not been located
recently and indicate its last known location and
direction of travel.
If the ID number of the requested entity is in
the database with a current timestamp then the central
computer, at step 1761, checks the database entry for the
entity to determine if it is available. A piece of
equipment may be marked as not available if it is
currently being used. A person may be marked as
unavailable if he or she is engaged in an important
assignment, such as responding to a "code-blue" alert.
If the requested entity is not available, the central
computer displays a message to that effect as step 1762.
If the entity is available, a message is displayed, at
step 1763, indicating the current location of the entity.
The emergency alert process illustrated in
FIGURE 17d builds upon the locator process shown in
FIGURE 17c to produce a process that attempts to
automatically assembly a team of specialists and
equipment to respond to an emergency situation. In the
first step in the process, step 1770, the central
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computer 432 determines the types of specialists and
equipment that are needed. This information may be
entered from a nurse station based on the condition of a
patient. The condition may be sent to the nurse station
with a patient initiated nurse call request, as set forth
above, or it may be sent automatically when the patient
station senses an alarm condition, such as an irregular
heart beat, from data provided by external equipment.
It is contemplated that the nurse station would
display a menu of, for example, five types of emergency
situation, each requiring a different mix of personnel
and equipment. One of these situations would be
indicated to the central computer 432. This indication
would provide the central computer with the types of
specialists and equipment needed and an indication of
which nurse station initiated the call.
Alternatively, an emergency alert may be
generated by a caregiver pressing the switch 1118 on her
badge transceiver. In this instance, a set of
specialists and equipment would be assembled that could
handle any situation.
At 1772, the computer 432 searches its
personnel and equipment database to obtain a list of
identifiers for each specialty type and for each type of
equipment. At step 1774, the computer 432 uses the
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1 locator process shown in FIGURE 17b to determine the
location and availability of each individual and piece of
equipment on each list. At step 1776, The computer
conditions the PBX to ring the telephone set that is
closest to the selected entities with a distinctive ring.
In response the distinctive ring someone near
the telephone would answer it and either listen for the
emergency message or see the message on the telephone's
~0 LCD display. If the requested individual has received
the message, he may press the switch 1118 to indicate
that he has responded. When this response is sensed, the
computer 432 will add the person to the assembled team.
Otherwise, the requested person would be
notified that he is needed by the individual who answers
the phone. The requested person would acknowledge
receiving the summons by pressing the button 1118 on his
badge. If a piece of equipment is being requested, the
individual who answers the phone may press the response
button on the badge attached to the requested piece of
equipment and send it to the requested location.
At step 1778, the central computer waits for a
fixed amount of time, for example 30 seconds, to
determine if all of the selected individuals and
equipment have responded. If so, the responders are
marked as unavailable and a full response message is
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1 displayed at the initiating nurse station 300 or at the
nurse station closest to the individual who initiated the
emergency alarm condition. This message includes a list
of all of the equipment and personnel that have
responded.
If, at step 1778, the central computer
determines that some needed specialists or equipment have
not responded, both the responding and non-responding
entities are deleted from the lists. These lists are
then passed to step 1774, described above, to locate the
next closest specialists and equipment.
The processes outlined above illustrate a few
aPPlications of a distributed processing system which may
be coupled to multiple personal databases. All of these
applications are in a hospital environment. A system of
this type has significant medical and non-medical uses
outside of a hospital environment.
FIGURE 18 is a block diagram of a secure
billing system for physicians and other professionals
whose charges are based on the amount of time spent with
a patient or client. To simplify the description, it is
assumed that the system is located in a physician's
office and is used for billing Medicare for services
provided by the physician.
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1 In general terms, the system operates as
follows. Each physician would be provided with one
system. When the physician is attending to each patient,
that patient's card is inserted into the system. Also,
the card of a third party, for example, an attending
nurse, is inserted to the system. The system records
identifying information from the cards and is provided,
either by the doctor or by other office personnel with a
diagnosis for the individual. The reason for the third
party card is to reduce the possibility of fraud, and to
provide an identifiable corroborating witness.
At the end of the day, the system automatically
dials up a central computer and transfer the day's
billing information. This information is then processed
to determine the amount due to the physician. This type
of system would speed the processing of Medicare bills by
eliminating much of the paper work. In addition, it is
advantageous because it is more difficult to generate
fraudulent bills using a system of this type.
As shown in FIGURE 18, an exemplary system of
this type includes a microcomputer 1810 which is coupled
to a modem 1812 through which data may be communicated to
the central database. In addition, the microcomputer
1810 is coupled to a keyboard 1811 and display device
1813 which may be used to enter data, such as a diagnosis
or prescription information into the computer system.
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1 These components exist in many commercially available
personal computer systems, for example, those that are
compatible with the IBM Personal Computer.
In addition to these basic computer components,
the system shown in FIGURE 18 includes a fault tolerant
time of day (TOD) clock 1814, a tamper alarm system 1818,
a patient memory card reader 1816, two staff memory card
readers 1824 and 1826, and a power supply 1822 with a
battery backup 1820. The system may also include
auxiliary identifying means 1817, such as a commercially
available fingerprint reader which can compare a person's
fingerprint against data describing the fingerprint which
is stored on the memory card 110.
The fault tolerant TOD clock 1814, tamper alarm
system 1818 and battery backup 1820 ensure that the data
provided by the billing system is accurate. The fault
tolerant clock may be, for example, of the type described
in a paper by D. Davies et al. entitled "Synchronization
and Matching in Redundant Systems", IEEE Trans. on
Computers, June, 1978, pp 531-539, which is hereby
incorporated by reference. The nature of the tamper
alarm system would depend on the construction of the
overall billing unit. At a minimum, the tamper alarm
would detect: any attempt to open the case enclosing the
unit and the insertion of an object other than a data
card into the data card reader. Any detected tampering
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would condition the system to both sound an audible alarm
and record the tampering event. Optionally, the tamper
alarm system could also disable the device. Any recorded
tampering events are sent to the central database with
the billing information.
The power supply 1822 and battery backup 1820
provide power to the tamper alarm 1818, microcomputer
1810, fault tolerant clock 1814, patient card reader 1816
and staff memory card readers 1824 and 1826 even when no
power is applied to the billing unit. The power supply
and battery backup may be any of a number of commercially
available components. The exact type of components used
would depend on the power requirements of the system and
~n the types of interruption that may be expected.
FIGURE 19 is a flow-chart diagram which
illustrates the program that controls the billing system
shown in FIGURE 18. This program is desirably stored on
ROM located securely within the case of the unit. The
process shown in FIGURE 19 operates in the background of
other processing performed on the microcomputer 1810.
Thus, the entire unit may be sold as a general purpose
computer system for word processing or general billing
while the automatic billing function runs in a background
mode.
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In this configuration, care must be taken to
ensure that no program which can interfere with the
automatic billing operations is allowed to run on the
system.
The first step in the program, step 1910,
receives an interrupt. The interrupt may be from the
tamper alarm 1818, patient memory card reader 1816, staff
memory card reader 1830, or fault tolerant TOD clock
0 1814. If, at step 1912, the interrupt is from the tamper
alarm, step 1914 is executed which sounds the audible
alarm and records the tampering event. After recording
the tampering event, the process, at step 1938, returns
control to the program that was running when the
~5 interrupt occurred.
If, at step 1916, the interrupt is caused by
any of the memory card readers 1816, 1824 or 1826, step
1918 is executed to determine if all cards are inserted.
20 If all cards are present, then a card has just been
inserted, step 1924 is executed to read the identifying
information from all of the cards and store this
information and the current time for later transmission
to the central database. Optionally, after step 1924 has
25 been executed, step 1925 may be invoked to verify the
identity of the patient and the attending physician. In
the exemplary embodiment, this identification is
accomplished by comparing fingerprint information stored
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on the cards with the actual fingerprint of the patient
and the physician. If the identity is verified, control
is transferred to step 1938, described above. Otherwise,
a violation is recorded at step 1934 and control is
returned to the foreground program at step 1938.
If, at step 1918, the patient card reader
interrupt occurs when less than all of the cards are
inserted, step 1919 is executed to determine if a
~0 treatment is currently in progress. If so, then one of
the patient card, physician card or nurse card was
removed to cause the interrupt. In this instance, step
1920 is executed to terminate the treatment, record the
stop time and request a diagnosis for the patient.
Either the physical or other office personnel enters the
diagnosis which is recorded at step 1922. After step
1922, control is transferred to step 1938, described
above. If, at step 1919, a treatment was not in progress
and at least one card is missing, control is returned to
the foreground program via step 1938 to await the
insertion of the remaining card or cards.
In the exemplary embodiment of the invention,
if the interrupt is not caused by the tamper alarm or one
of the card readers, then it must be caused by the clock
circuit 1814. At step 1928, the process determines if
the clock interrupt is from the interval timer. If so,
step 1930 is executed to read the identification
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1 information from each of the cards and compare it to the
stored identification for each individual. If any
difference is detected at step 1932, a violation is
recorded at step 1934. After step 1934 or if no error is
detected at step 1932, control is transferred to step
1938.
If the clock interrupt is not an interval timer
interrupt then it is an indication that it is time to
0 transfer the accumulated billing data to the main
computer. In this instance, step 1936 is executed. This
step dials the main computer and transfers the recorded
data along with data identifying the physician. In
addition, the computer, at step 1937, may condition a
Printer (not shown) to print out a record of the data
transferred for the physician's records. After step
1937, control is transferred to step 1938 to return
control to the program running at the time the interrupt
occurred.
The system described above in reference to
FIGURES 1-16 may be used in a hospital environment to
monitor the usage of controlled substances such as
prescription drugs. FIGURES 20a through 20e illustrate
an exemplary system for auditing drugs which are stored
in a drug locker. The invention does not significantly
impede the access of individuals to the drug locker,
unlike if using normal physical security measures such as
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a locker from heavy gauge steel and placing a lock on the
door.
FIGURE 20a is a cut-away top plan view of a
drug locker 2010 in accordance with this embodiment of
the invention. As shown, the drug locker is a physically
secure cabinet, having a door 2011 that may be locked by
lock 2012 and containing several medicine containers 130.
A stationary transceiver 2014 of the type described above
~0 with reference to FIGURE 15 is positioned close to the
drug locker. This stationary transceiver, however, is
coupled to receive signals from a keyboard unit 2015. In
addition, inside the locker a bar code reader 2016 is
positioned next to the door 2011 and a removal detector
2018 is concealed in the floor of the locker, positioned
so that any containers removed from the locker must be
passed over the detector 2018.
The detector 2018 may be a resonance detector
of the type commonly found in libraries and retail stores
which detects an induced resonant signal in a passive
reactive component 2022 attached to the bottom of each
medicine container 130, as shown in FIGURE 20c.
FIGURE 20b is a functional block diagram of the
drug monitoring system used in the drug locker. In
addition to the components shown in FIGURE 20a, the
system shown in FIGURE 20b includes an audible alarm
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1 2021, indicator lights and a door open detector 2019.
All of the system elements 2016 through 2021 are
configured to be controlled by the microcontroller 1512
of the stationary transceiver, as shown in FIGURE 15.
The stationary transceiver is, in turn, in communication
with and controlled by server 430 and central computer
432.
FIGURE 20d is a flow-chart diagram which
illustrates the portion of the drug audit process that
utilizes the circuitry shown in FIGURE 20b. At step
2050, whenever a badge transmitter normally worn by a
hospital staff member is within a preset distance, for
example, one meter of fixed transceiver 2014, the
transceiver receives the identification signal from the
badge at step 2052. Next, at step 2057, the keyboard and
display unit 2015 prompts for a personal identification
number (PIN) stored in the central computer 432 as being
associated with this badge. This PIN may be the same
number as is used to obtain the badge from the base unit
or, for enhanced security it may be a different number.
At step 2058, the transceiver sends a request
to the central computer 432 to compare the identification
signal and PIN with a predetermined list of authorized
personnel. Alternatively, this compare operation may be
performed using the microcontroller 1512 of the
stationary transceiver 2014 using an authorized list that
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1 is either stored locally, at the server 430 or at central
computer 432.
If, at step 2054, the ID signal is not found on
he list, access to the drug locker is denied at step
2060 and the unauthorized attempted access will be
recorded on central computer 432.
If at step 2058, the identification signal is
found on the list and the PIN is proper, access is
granted by fixed transceiver 2014 sending a signal to
release lock 2012 on door 2011.
If the individual is authorized to access the
locker, step 2064 records the identifying information and
the authorization information on the central computer
432. As each medicine container is removed from the
locker, it is scanned by the bar-code reader. When the
bar-code information has been scanned, the process
changes a value in a memory location to indicate that the
container may be removed.
The actual use of the prescription medicines
may also be monitored from the information provided to
the central computer 432. This information indicates the
individuals who had access to the drug locker, the time
they removed and returned the medicines, the patients to
whom the medicines were administered, the prescribed
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doses and, optionally, the amount of medicine that was
removed and the amount that was returned. This entire
auditing process could take place without significantly
impeding access to the drug locker.
FIGURE 20e illustrates the process of
monitoring the distribution of medicine that is obtained
in step 20d. The steps in this process are executed as
the medicine is given to the patients. At step 2080, the
0 nurse scans the patient bar-code on the wrist band 140
using either the patient station bar-code reader or the
portable nurse station bar-code reader. Next, at step
2082, the bar code on the medication is scanned. At step
2085, either the patient station computer 414 or the
~5 central computer 432, both shown in FIGURE 4, compares
the medication information with stored prescription
information for the patient. If a match is found, then,
at step 2090, the prescribed dosage of the medicine is
recorded in the central computer 432 as having been
20 distributed and the administration of the medication is
recorded in the patient's record in the central computer,
patient station computer and, optionally, on the
patient's memory card.
25 All of the applications described above relate
in some manner to the health care field. It is
contemplated, however, that significant applications for
the invention exist in areas other than health care.
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1 FIGURES 21a and 21b relate to an application of the
invention which establishes a student information link in
through a special telephone set in the student's
dormitory room.
As shown in FIGURE 21a, the telephone set 2110
is coupled to a dual-tone multifrequency (DTMF) decoder
2111, microcomputer 2112, a memory card reader/writer
2114, a voice synthesizer and a digital data port, such
as an RS232 link 2116. A data link between a central
computer (not shown) or network server (not shown), the
memory card reader/writer 2114 and the RS232 link 2116 is
established through the telephone set 2110 which is
coupled to a PBX (not shown).
In this configuration, the memory card may be
used as a standard identification card for directly
billing telephone calls or to allow access to student
records, assignment information, or a student bulletin
board, via a personal computer coupled to the RS232 port.
In addition, the memory card may be used for a
novel form of electronic funds transfer (EFT) as
illustrated in FIGURE 21b. The following scenario
illustrates how this system may be used. The student and
the parent are in a discussion and the student requests
funds from his parents. At step 2120, the patent enters
an initial code by depressing a particular sequence of
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1 buttons on the telephone. At step 2122, the
microcomputer 2122 determines if the card is in the
reader. If it is not, a distinctive tone or a voice
message from the synthesizer 2115 is emitted and the
telephone conversation continues normally.
If, however, at step 2122, the card is in the
reader 2114, step 2126 is executed in which the student
telephone is muted and the voice synthesizer 2115 is used
to prompt the parent for a personal identification number
(PIN). At step 2128, if the PIN is correct, the voice
synthesizer requests the parent to enter an amount to
enter on the debit card, repeats the request using the
voice synthesizer and requests verification from the
Parent. If, at step 2134, the parent verifies the amount
entered at step 2132, step 2136 is executed in which the
amount is added as a credit to the debit card and a debit
entry is made on a bill to be sent to the parents. If
the amount is not verified at step 2134, control is
transferred to step 2132 for the parent to reenter the
amount or to cancel the transaction.
If the PIN is not correct at step 2128, step
2130 is executed in which the microcomputer 2112 records
a violation on the central computer 432 and either
unmutes the student telephone allowing the conversation
to resume, or disconnects the telephone.
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In this embodiment of the invention, the credit
on the card may be used only at specified locations on
campus, for example, at the book store. As the funds are
spent, a record is made of the purchases and this record
is sent to the parent along with the debit entry on the
next account statement.
It is also contemplated that a locator and
emergency alert system such as described above in
reference to FIGURES 11 through 17 may be used in a
corrections environment to determine the location of
prison guards and trustees and to allow a prison guard to
signal an emergency alert. This locator system may also
be used as an automatic key station. For this use of the
system, a network of the same type as the network N2
shown in FIGURE 14 may be set up inside of a factory or
office building. In this network, each of the stationary
transmitters is programmed to continually receive
identification messages transmitted by the badges. As a
guard, wearing a badge transmitter passes the
transceivers, the identity information is transmitted
from the card and stored in a central computer as passing
through the transceiver. This system has advantages over
the traditional key station system since the guard need
not carry the bulky clock device and since the location
of the stationary transceivers may be concealed making it
more difficult for the guard to defeat the system by
taking a different route.
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1 SYSTEM CONFIGURATIONS AND COMMUNICATIONS
Fig. 24 is an illustration of the major components
of the patient care and communication system according to
the present invention, which includes central processor unit
(CPU) 2412, nurse control stations 2414, patient stations
2416, staff stations 2418 and zone controllers 2420.
Generally, the nurse control stations 2414 are installed at
nurse stations located in various areas of the hospital or
health care facility and provide a communication link to
Patients in their rooms. The patient stations 2416 are
installed in patient rooms and can be configured to
correspond to one patient or to multiple patients. The
patient stations 2416 include patient station display 3230,
speaker 3618, microphone 3620 and patient control unit 3210,
all of which will be described in more detail below.
The staff stations 2418 are preferably installed
in locations frequently occupied by other staff members in
the hospital, such as staff locker rooms. Staff stations
2418 include staff station display 2422, speaker 4018 and
microphone 4020, all of which will also be described in more
detail below. The zone controllers 2420 include shared-RAM
(S-RAM) memory 2512 (shown in Fig. 25) which is utilized as
a buffer memory for data received from either CPU 2412 or
from any of the above noted stations, hence the term shared-
As will be described in more detail below, the
various types of stations which are positioned at different
locations within the hospital interact with the aid of the
CPU 2412 to perform numerous operations to reduce the
information overload currently plaguing hospital staff
members. Examples of the operations involving CPU 2412
include a call priority operation which prioritizes incoming
calls (or messages) to nurse control station 2414 based upon
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the type of message received, so that staff members respond
to the highest priority calls first. For example, if the
incoming message relates to a fault in a smoke alarm secured
in the patient's room, that message will be given the
highest priority. Another operational example is a nurse
follow operation which allows staff members to selectively
route incoming calls directed to a nurse control station, to
selected patient stations and/or staff stations so that when
the staff members attending the nurse control station are
~0 required to leave the area, incoming calls to that station
can be routed to locations where appropriate staff members
can respond to the call. Another operational example is a
voice paging operation which allows staff members to
communicate with selected patient stations 2416 and/or staff
~5 stations 2418 from the nurse control station 2414. The
interaction between the stations when performing these
exemplary operations or tasks, as well as other operations,
is conducted via a communication link which will be
described in more detail below.
20 Fig. 26 illustrates the major components of system
2410 arranged in groups. As shown, CPU 2412 of the system
of the present invention is configured, dimensioned and
adapted to interface through zone controller systems 2413
with a predetermined number of station groups of patient
25 stations 2416, staff stations 2418, and/or any combination
thereof (e.g., the number of groups ranging between 1 and x,
where "x" is preferably 8). Each station group includes
between 1 and "n" stations, where "n" is preferably 35, and
a predetermined number of station groups can be assigned to
30 between 1 and "m" nurse control stations 2414, where "m" is
preferably 8. For example, if a ward in a hospital has one
hundred patient rooms (numbered from 100 to 200) which are
single occupancy rooms, a staff locker room (Room 201) and a
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staff kitchen (Room 202), one patient station 2416 would be
installed in each patient room and one staff station 2418
would be installed in the staff locker room and the staff
kitchen. An exemplary array of station groupings (or the
call assignment configuration) is shown in Table I below:
Table I
RM1 RM2 RM3.....RM32 RM33 RM34 RM35
GROUP 1 100 101 102.....132 133 201 202
GROUP 2 120 121 122.....152 153 201 202
GROUP 8 154 155 156.....186 187 201 202
As shown in this exemplary call assignment configuration,
rooms 100 through 133, 201 and 202 are assigned to station
group 1. Rooms 120 through 153, 201 and 202 are assigned to
station group 2 and rooms 154 through 187, 201 and 202 are
assigned to station group 8. The station groupings can
overlap in room coverage, thus, as illustrated in table I
above, station groups 1 and 2 both include rooms 120 through
133.
In addition to the station groupings, the system
of the present invention is configured so that each station
group is assigned to a predetermined number of nurse control
stations 2414. Table II below, illustrates an exemplary
call assignment configuration for station groupings and
their assignment to the nurse control stations 2414:
Table II
Group 1 Group 2 ..... Group 8
NCS1 YES YES ..... YES
NCS2 YES NO ..... NO
NCS8 NO YES ..... NO
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1 In this exemplary configuration, communication transmitted
by any of the stations assigned to station group one (rooms
100-133, 201 and 202) will be directed to nurse control
station one (NCS1) and to NCS2 so that staff members
attending either nurse control station 2414 can respond to
the call. Communications transmitted by any of the stations
assigned to station group two (rooms 120-153, 201 and 202)
will be directed to NCS1 and NCS8 so that staff members
attending either nurse control station 2414 can respond to
1p the call. Communications transmitted by any of the stations
assigned to station group eight (rooms 154-187, 201 and 202)
will be directed to NCS1 so that staff members attending
NCS1 can respond to the call.
In the preferred embodiment, the patient care and
co~unication system of the present invention can include
four call assignment configurations. To illustrate, the
call assignment configurations can be utilized to
automatically (or manually) assign stations (2416 or 2418)
to station groups and station groups to nurse control
stations 2414 for day operation, for evening operation, for
weekend operation and/or for holiday operation.
Referring now to Fig. 27 which illustrates an
alternative system configuration in which, central
processing unit 2412 is connected to external communication
e~ipment such as broadcast paging system 2720, external
computer 2722, printer 2724, and/or staff locator system
2428. Broadcast paging system 2720 may be utilized by the
system of the present invention to locate staff members or
other personnel who are not within the hospital or other
health care facility. The broadcast paging system may be
any known type capable of interfacing with a computer.
Preferably, broadcast paging system 2720 and CPU 2412
communicate via serial communication ports connected to each
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device. Staff locator system 2428 may be provided to locate
staff members anywhere in the hospital or other health care
facility as described above with reference to Figs. 1-23.
In addition to locating staff members, staff locator system
2428 may be utilized to track or locate patients in the
hospital. To utilize the staff locator system to locate
patients, each patient is provided with an identification
badge or bracelet 140 (shown in Fig. ld) which includes the
components as disclosed for identification badge 1111 worn
0 by staff members and described above. The identification
badge 1111 or bracelet 140 continually transmits the
identification signal of the patient and central computer
system 432 continually monitors the identification signal to
update the location of the bracelet and the patient. The
location information of the staff member or patient is
transferred to CPU 2412 via data link 2726 (shown in Fig.
27) which may be any known type of communication link
utilized to facilitate communication between computer
systems. External computer 2722 interfaces to CPU 2412 and
performs computing functions including extracting or
inputting data stored or otherwise processed within CPU
2412. Printer 2724 may be utilized to extract hard copies
of data stored or otherwise processed within CPU 2412
including problem reports generated by the system, as will
be described in more detail below.
Fig. 25 illustrates a functional block diagram of
an alternative system configuration, which includes main
hospital computer 2530 configured to interface with CPU 2412
to provide staff members with additional patient
information, or to transfer from CPU 2412 to the main
hospital computer patient information which may be utilized
for billing purposes. For example, information pertaining
to the types and quantities of prescription or intravenous
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1 drugs taken by the patient and the types of treatments
received by the patient (e. g., X-rays or CT-scans), as well
as the physician time spent with the patient, may be
transferred to the main hospital computer to provide the
hospital with more accurate billing information.
Preferably, main hospital computer 2530 is interfaced with
CPU 2412 via hospital personal computer 2540, system
personal computer 2550, RS-232/RS-484 converter 2520 and
zone controller 2560. In this configuration, the integrity
~0 of the main hospital computer is maintained and the serial
conversion from RS-232 protocol to RS-484 protocol is
accomplished.
Fig. 28 illustrates the hardware components of
central processing unit (CPU) 2412. The CPU 2412 includes
microprocessor 2810, three Mbytes of memory 2820 (2 Mbytes
of flash ROM and 1 Mbyte of RAM) having stored programs
(e.g., operating system and application programs), and
communication interface 2830. Preferably, microprocessor
2810 is an MC68000 16-bit microprocessor manufactured by
Motorola Inc. In addition to the above circuits, CPU 2412
includes watchdog circuit 2840 which receives a one shot
trigger from microprocessor 2810, at a predetermined time
interval, preferably 300 msec., to ensure that the
microprocessor is functioning. If, however, microprocessor
2810 fails to timely trigger watchdog circuit 2840, then the
watchdog circuit will initiate an automatic reset of the
microprocessor, thus preventing the microprocessor from
locking-up for extended periods of time.
Communication interface 2830 and communication
Ports 2850 are provided to facilitate communication between
CPU 2412 and zone controllers 2420 and between CPU 2412 and
the external communication equipment. As noted above, the
preferred communication protocol includes the RS-485 serial
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1 communication protocol. Accordingly, communication
interface 2830 is configured to accommodate RS-485
communication utilizing RS-485 drivers/receivers which are
known in the art.
An exemplary operational flow of CPU 2412 is shown
in Fig. 29. Initially, the CPU is in a listen mode. In the
listen mode the CPU continuously polls or otherwise
interrogates the different components attached thereto. For
example, as shown in Fig. 29, the CPU will periodically poll
each shared-RAM (S-RAM) 2512 (shown in Fig. 25) of each zone
controller (step 2910) in a manner described hereinbelow.
If the S-RAM does not have a message frame received from a
station within the zone controller grouping, CPU 2412
returns and polls the next zone controller (step 2920).
Preferably, as will be described in more detail below data
transmitted between the CPU 2412 and the zone controller
2420 or between the zone controller 2420 and the stations
(either 2414, 2416 or 2418) are in the form of message
frames which include station identity information as well as
the message data relating to a particular function.
If, however, the S-RAM does have a message frame
stored therein, CPU 2412 will retrieve the message frame
(step 2930) and analyze the received message frame by
determining what patient station, staff station or nurse
control station the message frame was received from and if
the frame was received from a patient station, by organizing
or obtaining any patient information associated with that
particular patient station (step 2940). The DATA field
within the INFORMATION field of the received message frame
is then interpreted by the CPU, which determines whether a
response to the associated patient station, staff station or
nurse control station message frame is necessary (step
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1 2950). If a response is not required, CPU 2412 returns to
poll the next zone controller.
However, if a response is due, the CPU then starts
the task associated with the information included in the
message frame (step 2960). Upon completion of the task, CPU
2412 returns to the listen mode and begins polling the next
zone controller connected thereto as described above.
The components of zone controller 2420 include a
microcontroller, memory having stored programs (e. g., system
or application programs) and a communication interface
connected to communication ports. The connection of the
zone controller 2420 components is the same as equivalent
components of CPU 2412, as shown in Fig. 28. The zone
controller 2420 also includes the shared-RAM (S-RAM) 2512,
shown in Fig. 25, which is connected to the microcontroller.
Preferably, the microcontroller is the 64180
microcontroller, manufactured by Motorola and the S-RAM
includes 2 kilobytes of memory.
A communication interface and communication ports
are provided to facilitate communication between zone
controller 2420, CPU 2412 and slave devices, such as patient
station 2416, staff station 2418 and/or nurse control
station 2414. The communication protocol may be any known
serial communication protocol, such as RS-232 or RS-485.
The RS-485 protocol is preferred in the embodiment according
to the present invention. Accordingly, the communication
interface is configured to accommodate RS-485 communication
utilizing RS-485 drivers/receivers which are known in the
art. Each zone controller 2420 also includes a watchdog
circuit which operates similarly to the watchdog circuit in
CPU 2412. Thus, the watchdog circuit prevents the
microcontroller from locking-up if the watchdog circuit is
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not polled at the predetermined time interval, preferably
300 msec., by the microcontroller.
The communication link between the zone
controllers and stations or between the stations and
peripheral equipment connected to the station is in a
master-slave relationship. In the communication link
between the zone controllers 2420 and the stations, the zone
controllers are the master stations and the nurse control
stations, patient stations or staff stations are the slave
0 stations. Whereas, in the communication link between the
stations and the peripheral equipment, the stations (e. g.,
the patient stations) are the master stations and the
peripheral equipment is the slave. The master station is in
control of the data link and transmits command frames to the
~5 slave stations. The master station maintains separate
sessions (i.e., communication links) with each slave station
attached to the link. To illustrate and again referring to
Fig. 25, if zone controller 2420 is connected to a group of
patient stations (1 to n) and/or connected to a group of
20 staff stations (1 to n), the zone controller (master) will
periodically poll each patient station (slave) to retrieve
message frames. The slave station responds to the commands
from the master station and can send one message to the
master station per poll from the master station.
25 The master station may communicate with the slave
stations in one of two logical states. One state is the
INITIALIZATION state which is used to initialize the
master/slave station (e. g., identify for each communication
link which device connected thereto is the master and which
30 is the slave). A second state is the INFORMATION TRANSFER
state which permits the master and slave stations to
transmit and receive control or application information
transmitted across the data link between the master station
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and the slave stations in the form of message frames or
blocks of data.
In the preferred embodiment, the message frames
may be one of three types. The first type of message frame
is the INFORMATION FORMAT frame (I-frame) which is used to
transmit application information (e. g., message information
associated with a particular function or station status
data) between the master and slave stations. The I-frame
may also acknowledge receipt of a frame from a transmitting
~0 station. The second type of message frame is the
SUPERVISORY FORMAT frame (S-frame) which performs control
functions, such as acknowledging the receipt of a poll from
the master station or requesting the temporary suspension of
the transmission of I-frames. The third type of message
frame is the UNNUMBERED FORMAT frame (U-frame) which is also
used for control purposes, such as performing data link
initialization or tests.
As noted, the data (or information) transmitted
between master and slave stations is preferably configured
in the form of a message frame. The preferred message frame
includes five fields, similar to the frame shown below:
ADDRESS/LENGTH/CONTROL/INFORMATION/FCS
Where, the ADDRESS field is one byte in length and
identifies the patient station involved in the particular
frame transaction (each station has a unique address which
allows the CPU and zone controller to identify which station
sent the frame); the LENGTH field is one byte in length and
contains the size of the frame, in bytes, excluding the
address and length fields; the CONTROL field includes the
command and response information used to maintain data-flow
accountability of the communication link between the zone
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controller (master) and the patient station (slave): and the
INFORMATION field retains a predetermined number of bytes of
data, preferably between 1 and 145 bytes, relating to the
application data, such as, the data associated with the
activation of the nurse call button (hereinafter "the nurse
call data"). The frame-check-sequence (FCS) field,
typically one byte in length, is used to check for
transmission errors between the master and slave stations or
devices.
0 The system of the present invention may transmit a
predetermined number of message frames, preferably between 1
and 8 frames, before an acknowledgement or response to a
transmitted frame is received. As a result, the CONTROL
field is utilized to maintain data-flow accountability of
I5 the communication link, as noted above.
Shown in table III below is the CONTROL field bit
encoding for the master and slave stations.
Table III
CONTROL field bit encoding (master station):
20 I-frame format:
:7:6:5:4:3:2:1:0:
. x x . x x . 0
. . . . , . . .-> Normally set to binary 0
--> N(s)
. . . . --______> N(R)
25 ,
______________> p
CONTROL field bit encoding (slave station):
I-frame format:
:7:6:5:4:3:2:1:0:
30 . x x . x x . 0
. . , . . . .-> Normally set to binary 0
--> N(S)
. . . . --______> N(R)
_ _-________-___> F
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1 The send sequence number N(S) (bits 1, 2 and 3)
indicates the sequence number associated with a transmitted
frame. Basically, the sequence number is a message counter
which counts the number of message frames sent to a
receiving station. The receive sequence number N(R) (bits
1, 2 and 3) indicates the next sequence number that is
expected at the receiving station. The receive sequence
number may also serve as an acknowledgement of the previous
frame. In addition, the transmitting station maintains a
~~ send state variable V(S) which is the sequence number of the
next message frame to be transmitted, and the receiving
station maintains a receive state variable V(R), which
contains the number that is expected to be in the sequence
number of the next frame. The send state variable is
incremented with each message frame transmitted and placed
in the send sequence number N(s) field in the frame.
Upon receiving a frame, a receiving station checks
for a transmission error by comparing the send sequence
number with the receive state variable. If the frame is
2~ acceptable (i.e., the send sequence number and the receive
state variable are equal), the receiving station increments
the receive state variable V(R) and interpolates the
variable into the receive sequence number field N(R) in the
next outbound message frame. If, on the other hand, the
send state variable V(S) does not match the receive sequence
number N(R) in the message frame, the receiving station
decrements the send state variable V(S) and retransmits the
last message frame when the next frame has to be
transmitted.
To establish an interactive communication link
between stations, the master station uses the poll bit (P)
to solicit a status response (e.g., an S-frame) or an I-
frame from a slave station. Generally, the slave station
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1 does not transmit a frame to a master station until a
message frame with an active poll bit (i.e., P is set to
logic 1) is received from the master frame. In the
preferred embodiment, the polling rate of the master station
is aperiodic or not fixed. The polling rate is dependent
upon a number of factors such as the band rate and the type
of message frame being sent by the slave station. For
example, if the baud rate is 9600 and if all the slave
stations respond to a poll by the master station with a S-
frame, the polling rate is approximately 20 msec. However,
if a slave station responds with an I-frame which includes
64 bytes of display data the rate (or time) before the
master station will poll the next slave station is
approximately 64 msec. Generally, at 9600 baud, one byte of
data is transferred in one millisecond.
The slave station responds to an active poll bit
with an I-frame or S-frame format message frame. In the
preferred embodiment, the slave station has 15 msec. to
start transmitting the responding message frame and 150
cosec. to complete transmission of the frame which is
identified by activating the Final bit (F) (i.e., F is set
to a logic 1).
If the slave station fails to successfully respond
to the polling frame of the master station with either an S
frame or an I-frame, for a predetermined number of polls,
preferably 10, that particular station will be marked as
disconnected and will be polled at slower rate (preferably,
about every 10 sec.) until the master station receives at
least one message frame from that particular slave station.
When a station or other equipment connected to the system of
the present invention are determined to be disconnected, the
identity of the station or other equipment and the room
location of the equipment are stored in a problem report
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1
which can be printed on hard or soft copy via printer 2724
and/or external computer 2722, shown in Fig. 4.
Alternatively, the problem report can be displayed on nurse
control station display 3272 shown in Fig. 32 upon the
proper keying of direct select keys 3374 of nurse control
station display 3272 pursuant to menu prompts.
Referring now to Table IV below, the CONTROL field
encoding for the commands and responses used by an S-frame
are shown:
Table IV
CONTROL field bit encoding (master station):
S-frame format:
:7:6:5:4:3:2:1:0:
. x x . . . 0 1
~ ~ ~ ~ -> Normally set to binary 1
' ~
~ ~ ~ . . . ----> Commands:
~ ~ ~ ~ ~ . ----> Binary 0 - Receive Ready (RR)
~ ~ ~ ~ ~ ~ ----> Binary 1 - Receive Not Ready (RNR)
. . . . ________> N(R)
. ______________> Poll bit (P)
CONTROL field bit encoding (slave station):
S-format:
:7:6:5:4:3:2:1:0:
. . . . . . 0 1
~ ~ . . . . . -> Normally set to binary 1
~ ~ . . . . ----> Commands:
~ ~ ~ ~ ~ ~ ----> Binary 0 - Receive Ready (RR)
~ ~ ~ ~ ~ ~ ----> Binary 1 - Receive Not Ready (RNR)
. . . . --______> N(R)
~ '-'-----------> Final bit (F)
The receive ready (RR) command is used by either
the master or the slave station to indicate that it is ready
to receive an I-frame and/or acknowledge previously received
frames by using the receive sequence number. If a station
had previously indicated that it was busy by using the
receive not ready (RNR) command, the station then uses the
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1 RR command to indicate that it is now free to receive data
(e. g., an I-frame).
As noted, receive not ready (RNR) is used by a
receiving station to indicate a busy condition in response
to polling by a master station. This notifies the
transmitting station that the receiving station is unable to
accept I-frames. The RNR command may also be utilized to
acknowledge a previously transmitted frame by using the
receive sequence number.
0 The commands and responses used by a U-frame are
shown below in Table V:
Table V
CONTROL field encoding (master station)
U-frame format:
:7:6:5:4:3:2:1:0:
. . . . . . 1 1
~ ~ ~ ~ ~ . ~ .-> Normally set to binary 3
. . . . . . ----> Commands:
. . . . . . ----> 0 - Set Init. Mode (SIM)
. . . . . . ----> 1 - Reset Init. Mode (RIM)
. . . . . . ----> 2 - Test Message (TM)
. . . . . . ----> 3 - Loop Back (LB)
. . . . . . ----> 4 - Broadcast (BC)
.
______________> Poll bit (P)
CONTROL field encoding (slave station)
U-format:
:7:6:5:4:3:2:1:0:
1 ~ ~ ~ . . 1 1
. . . . . . . .-> Normally set to binary 3
. . . . . . ----> Commands:
. . ~ , . . ----> 0 - Set Init. Mode (SIM)
. . . . . . ----> 1 - Reset Init. Mode (RIM)
. . . . . . ----> 2 - Test Message (TM)
. . . . . . ----> 3 - Loop Back (LB)
,
--------------> Final bit (F)
The set initialization mode (SIM) is used by a
master or slave station to initialize the master/slave
session (or communication link). The SIM command puts the
master and slave stations in the initialization state. Upon
receiving the SIM command, the receiving station clears the
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1 send state variable number V(S) and the receive state
variable V(R), thus clearing a retransmit buffer (not
shown). The SIM command is used by a station on power-up or
to clear a lock-up condition of the station. The reset
initialization mode (RIM) is used by a master or slave
station to set an information transfer state. This command
also serves as an acknowledgement of the SIM command.
The test message (TM) command is used to test data
lines. The receiving station responds with a LB command
1p which carries (or echoes back) the same data received from
the message frame where the TM command was active. Failure
of a slave station to echo back the same data received in
the message frame causes the master station to identify the
station as disconnected and the station identity and
location are added to the problem report.
The broadcast (BC) command (bits 2-6) is used by a
master station to transmit data to all slave stations. The
master station sends this command while the P bit is set to
a logic zero and the address field of the message frame,
noted above, contains "FF" hex.
The bit encoding for the INFORMATION field of the
message frame noted above will now be described.
Preferably, the INFORMATION field consists of four fields
which identify the priority level of the message frame, the
station ID, the type of message and data to augment the
message type:
PATH/RSP-ID:REQ_ID/DATA/O
The PATH field, shown below in Table VI, may be
four bytes in length and contains routing information and
frame transition priority data. The transition priority
data identifies to the CPU the priority level associated
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1 with the received I-frame. As a result, the system of the
present invention can prioritize incoming message frames so
as to organize staff responses thereto in order of priority,
as will be described in more detail below. The last byte of
this field preferably includes an address expansion bit
which when set to logic one identifies that the next byte of
data is the station address field which identifies which
slave station is sending the message frame.
Table VI
PATH field bit encoding:
:7:6:5:4:3:2:1:0:
. . . . . . . .-> Station Address
~ ~ ~ ----------> Priority: binary 2 - alarm,
binary 1 - event/control,
~ . . ----------> binary 0 - data type
~ --------------> Address expansion set to logic
1=next byte is station address
The RSP_ID:REQ_ID field, shown below in Table VII,
contains response/request tag (ID) data. Upon receiving a
request message (type bit is set to logic 1), the slave
station sends a specific response message (e.g., an I-
frame). If there is no specific response, the slave station
sends generic acknowledgement typically in the form of an S-
frame.
Table VII
RSP_ID:REQ_ID field bit encoding:
:7:6:5:4:3 2:1:0:
~ ~ ~ ~ ~ ~ ~ --> response/request ID
. ~ ------------> local master: binary 1 = local master
request/response
~ --------------> type: logic 1 = request,
logic 0 = response
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1
Generally, the DATA field may be 128 bytes in
length and contain application specific data and preferably,
consists of three fields:
LENGTH/DTYPE/TEXT
Where, the LENGTH field, typically 1 byte in
length, contains the size in bytes of the DTYPE and TEXT
fields; the DTYPE field, typically one byte in length,
contains data codes such as the type of message being sent,
e.g., code blue; and the TEXT field which may be 126 type
in length, contains application specific data, e.g., message
data associated with a particular function or station status
data, which is utilized to augment the DTYPE field by
identifying a textual message associated with the particular
function identified in the DTYPE field. For example, if the
DTYPE field identifies a ~~code blue~~ code, the TEXT field
will include the text which should be displayed on other
stations, such as the staff station.
In the event of a failure within the CPU 2412, the
system of the present invention also provides a fail safe
feature which is activated upon detection by the nurse
control stations 2414, the patient stations 2416 and/or
staff stations 2418. An exemplary embodiment of the
configuration for fail safe operation is shown in Fig. 30.
In this configuration, fail safe bus (FSB) 3020 is connected
between each patient station 2416, each corresponding staff
station 2418 and zone indicator assembly 3022. If a failure
°ccurs in the CPU 2412, each patient station 2416 and
corresponding staff station 2418 will fail to receive a
polling signal from their corresponding zone controllers.
As a result, each station will operate in a local mode
utilizing the fail safe bus. When in the local mode,
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activation of any of the functions which have access to the
fail safe bus will cause a response at a particular patient
station, the staff stations and at the zone indicator
assembly connected to the group, to allow staff members in
the vicinity of the station utilizing the fail safe bus to
respond.
An operational flow associated with the above
described exemplary fail safe feature will be described with
reference to Figs. 30-32. As noted, upon failure of he CPU
2412, the stations associate with the system of the present
invention operate in the local mode. In response to
activation of a fail safe device (e. g., the nurse call
button 3250, the code blue switch 3234 or the emergency
switch 3232) the system first determines whether the cause
of the fail safe was from the activation of nurse call
button 3250 of patient control unit 3210 (shown in Fig. 32)
(steps 3110 and 3120). Nurse call button 3250, code blue
switch 3234 and/or emergency switch 3232 are connected to
patient station 2416 and provide either a general indication
to staff members that the patient needs assistance or an
emergency indication relating to the patients immediate
health condition. Nurse call button 3250 allows the patient
to indicate the need for general assistance, whereas, code
blue switch 3234 and emergency switch 3232 allow staff
members to activate the appropriate staff response to the
patient's health condition. For example, if the patient is
experiencing a heart attack a staff member would activate
the code blue switch.
If the cause of the fail safe was due to the
activation of nurse call button 3250, the patient station
responds by activating nurse call indicator 3222 of
indicator assembly 3220 associated with that particular
patient station and by displaying a "nurse call" message on
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patient station display 3230 (step 3122). Next, the staff
stations 2418 (shown in Fig. 24) associated with the group
of patient stations 2416 respond by displaying a "nurse
call" message on the staff station display 2422 (step 3124).
Zone indicator assembly (ZIA) 3022 activates the nurse call
indicator of zone indicator 3024 (e. g., indicators 1 through
8, shown in Fig. 30) associated with the particular group of
patient stations (step 3126). For example, if the nurse
call button is activated by a patient station associated
with group 1, the nurse call indicator of the group 1 zone
indicator 3024 associated with zone indicator assembly 3022
will be activated. Manual reset of the patient station by a
staff member responding to the call returns the FSB and the
patient stations to the idle local mode (step 3128).
If the cause of the fail safe was not from the
activation of the nurse call button, the fail safe system
then determines if the fail safe was caused by the
activation of emergency switch 3232 (step 3130). If fail
safe operation was caused by the activation of emergency
switch 3232, patient station 2416 responds by activating the
emergency indicator associated with that patient station and
by displaying an "emergency" message on patient station
display 3230 (step 3132). Preferably, the emergency
indicator is the same indicator as nurse call indicator
3222. However, activation of indicator 3222 in the
emergency mode results in a blink light at a predetermined
rate in pulses per minutes (PPM) as illustrated in the table
of Fig. 42. Whereas, activation of indicator 3222 in the
nurse call mode results in a steady lamp intensity. Second,
staff station or stations 2418 associated with the subject
patient station, displays an "emergency" message on staff
station display 2422., shown in Fig. 24 (step 3134.). Next,
zone indicator assembly 3022 activates the emergency
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indicator of zone indicator 3024 associated with the group
with which the particular patient station belongs (step
3136). Staff members responding to the emergency call,
manually reset emergency switch 3232 (step 3138), thus
returning the fail safe system to the idle local mode.
If, on the other hand, the cause of the fail safe
was not from the activation of an emergency switch, then,
according to this exemplary embodiment, the fail safe
operation was activated by code blue switch 3234. The
patient station responds to the code blue call by activating
code blue indicator 3228 associated with patient station
2416 to which the code blue switch is operatively connected,
and by displaying a "code blue" message on patient station
display 3230 (step 3140). Secondly, staff station or
Stations 2418 associated with the group of patient stations
2416, displays a "code blue" message on station display 2422
(step 3142). Zone indicator assembly 3022 also activates
the code blue indicator associated with the subject patient
station group number (step 3144). Manual reset of code blue
Switch 3234 by the responding staff members returns the fail
safe bus to the idle local mode (step 3146).
NURSE CONTROL STATION
The nurse control portion of the present invention
will now be described with reference to Figs. 32 and 33.
Fig. 32 illustrates a system configuration in which
peripheral equipment is connected to patient station 2416
and in which nurse control station 2414 includes main
processor 3270, keyboard 3236 and nurse control station
display 3272. Nurse control station display 3272 can be
user programmed to perform functions, such as initiating a
code blue operational sequence, either through keyboard 3236
or direct select keys 3274. The direct select keys 3274
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allow staff members to select specific functions in response
to menu driven prompts.
Fig. 33 is a block diagram which illustrates
hardware components for nurse control station 2414. Nurse
control station 2414 includes main processor circuitry 3310,
keyboard circuitry 3312 and display circuitry 3314. Main
processor circuitry 3310 includes microprocessor 3316, such
as the 16 bit model 286 microprocessor manufactured by Chips
& Technology, Inc., 2 Mbytes of memory 3318 having stored
programs (e.g., system and application programs) and
communication interface 3320 connected to communication
ports 3322.
Preferably, communication interface 3320 and
communication ports 3322 are provided to facilitate data
communication between zone controller 2420, CPU 2412 and the
nurse control station 2414. As noted above, the preferred
communication protocol includes the RS-485 serial
communication protocol. Accordingly, communication
interface 3320 is configured to accommodate RS-485
communication utilizing RS-485 drivers/receivers which are
known in the art.
Keyboard circuitry 3312 includes microcontroller
3324, such as model 8052 manufactured by Intel, which
includes internal memory having, preferably, 4 Kbytes of ROM
and 256 bytes of RAM, keypad interface 3326 which is
connected to keys 3328 and facilitates communication between
a staff member and the nurse control station. Communication
interface 3330 and communication port 3332 are provided as a
data communication link to main processor circuitry 3310.
As noted, the preferred communication protocol includes the
RS-485 serial communication protocol. Accordingly,
communication interface 3330 is configured to accommodate
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1 RS-485 communication utilizing RS-485 drivers/receivers
which are known in the art.
Keyboard 3236 (shown in Fig. 32) includes speaker
3338, handset 3340 and microphone 3342 which facilitate
audio communication between nurse control station 2414,
patient stations 2416 and/or staff stations 2418, via audio
controller 3344. The audio circuit portion 3410 of nurse
control station 2414 will now be described with reference to
Fig. 34, which illustrates the hardware configuration for
the audio portion of the keyboard. As shown, audio pair
3412 from main processor 3270 of nurse control station 2414
(shown in Fig. 32) is connected to the front end of audio
controller 3344. Preferably, the front end of audio
controller 3344 includes a coupled 600 ohm balanced
transformer 3414 which isolates the internal audio circuitry
of nurse control station 2414 from the external audio
circuits. Depending upon whether the audio signal is being
received or transmitted, the back end of audio controller
3344 either directs the audio signal to keyboard speaker
3338 or to handset 3340, or directs the audio signal from
microphone 3342 to transformer 3414.
Preferably, audio controller 3344 is a 34118 audio
controller manufactured by Motorola. Audio input signals
from main processor 3270 of nurse control station 2414,
which pass through the audio controller are directed to
keyboard speaker 3338 via amplifier 3416 or to handset 3340
via relay controller 3418 controlled by microcontroller 3324
(shown in Fig. 33). Audio generated by the nurse control
station via microphone 3342 or handset 3340 is transferred
through relay controller 3418 to audio controller 3344 and
onto the audio pair as shown. The audio pair from keyboard
circuitry 3312 is directed to the equipment panel via main
processor circuitry 3310, as shown in Fig. 33.
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Display circuitry 3314 includes microprocessor
3346, such as model 8051 manufactured by Intel, memory 3348
having stored programs (e. g., system and application
programs), video controller 3350 which is connected to nurse
control station display 3272 and facilitates the display of
the visual communication signals. Select key interface 3352
is connected to direct select keys 3274 and is provided to
identify to microprocessor 3346 which direct select key 3274
has been depressed. Communication interface 3354 and
communication port 3356 are provided as a data communication
link to main processor circuitry 3310. As noted, the
preferred communication protocol includes the RS-485 serial
communication protocol. Accordingly, communication
interface 3354 is configured to accommodate RS-485
communication utilizing RS-485 drivers/receivers which are
known in the art.
PATIENT STATION
The patient station portion of the present
invention will now be described with reference to Figs. 27,
32 and 35-37. Turning initially to Fig. 32, patient station
2416 is a microprocessor controlled interface between CPU
2412, the patient bedside equipment and peripheral
equipment. The communication link between CPU 2412 and the
bedside or peripheral equipment is via the master/slave
communication link described above. Examples of the patient
bedside equipment include heart monitors, respirators, pulse
oxymeters or I.V. pumps which include data communication
ports to serially transmit data. Examples of peripheral
e~ipment include patient control unit 3210, staff presence
switch 3254, indicator assembly 3220, code blue switch 3234,
emergency code switch 3232 and/or a smoke detector (not
shown). Staff presence switch 3254 is preferably located by
the door of the patient rooms and is provided to activate
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indicator 3220 and to cause patient station 2416 to send a
message frame to CPU 2412 indicating the particular type of
staff member who is present in the patient's room, as will
be described in more detail below. In addition, patient
station 2416 may be operatively connected to a side-rail
communication system (not shown) installed in a side-rail of
the patient's bed, as well as bed sensors which sense
whether the patient is in the bed. Side-rail communication
system may be connected to the audio output ports 3624,
shown in Fig. 36, to facilitate audio communication at the
side-rail.
Fig. 35 is a circuit block diagram for the patient
station circuitry 3510 installed within patient station
2416. The patient station circuitry 3510 includes
microprocessor 3512, such as model 64180 manufactured by
Motorola operating at a frequency of 12.888 MHz. via crystal
3514, 96 Kbytes of memory 3516 (e.g., 64 Kbytes of flash ROM
and 32 Kbytes of RAM) having stored programs, e.g., system
and application programs. In this exemplary configuration,
the data and address buses of the microprocessor are
connected to memory, e.g., RAM 3518 and an EPROM 3520.
Memory decoder 3522 is utilized to select between RAM 3518
and EPROM 3520 in response to a particular address on the
address bus. The address bus is also connected to a pair of
latches 3524 and 3526 which interface the microprocessor to
status indicators, the fail safe bus (FSB), the audio
control circuitry, and to switches and other peripheral
equipment connected to the patient station, as shown. In
addition, I/O decoder 3528 is utilized to select between
either latch in response to a particular address on the
address bus. Incoming signals from the above noted
peripheral equipment are received by buffer 3530 and then
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transferred to the data-bus upon being enabled by I/O
decoder 3528.
Utilizing the preferred microprocessor 3512 (i.e.,
the Motorola 64180), serial communication between the zone
controller 2420 and microprocessor 3512 or between the
bedside equipment and microprocessor 3512, may be
accomplished through either one of two asynchronous serial
communication ports 3532 and 3534 which are, preferably,
configured to RS-485 protocol utilizing RS-485
driver/receivers (RS-485 D/R) 3536 and 3538 as shown.
Fig. 36 is a circuit block diagram for the audio
portion 3610 of patient station 2416. As shown, audio pair
3612 from an equipment panel (e. g., audio matrix 2510 shown
in Fig. 25) is connected to the front end of audio
controller 3614. Preferably, the front end of audio
controller 3614 includes a coupled 600 ohm balanced
transformer 3616 which isolates the internal audio circuitry
of patient station 2416 from the external audio circuits.
Depending upon whether the audio signal is being received or
transmitted, the back end of audio controller 3614 either
directs the audio signal to patient station speaker 3618 or
to an external audio speaker, such as speaker 3252 of
patient control unit 3210, shown in Fig. 32, or directs the
audio signal from microphone 3620 to transformer 3616.
Preferably, audio controller 3614 is a 34118 audio
controller manufactured by Motorola. Audio input signals
from audio matrix 2510 which pass through the audio
controller are directed to patient station speaker 3618 via
amplifier 3622 and/or to audio output ports 3624 via
amplifier 3626 and relay controller 3628. Audio signals
generated by the patient station via microphone 3620 are
selectively transferred through audio controller 3614 onto
the audio pair as shown. Mute switch 3630 may be provided
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to allow a staff member to manually short out the microphone
so as to prevent audio signals from being generated at the
patient station. In addition, the audio circuitry for the
patient station may include input audio ports 3632 which
facilitate a connection between external entertainment
equipment, such as a television or a radio, and audio output
ports 3624 via relay switch 3628. To illustrate, audio
signals from a television in the patient's room can be
directed from patient station 2416 to speaker 3252 in
patient control unit 3210 (shown in Fig. 32) to bring the
audio from the television closer to the patient.
Referring again to Fig. 32, each patient station
2416 may be coupled to external peripheral equipment, such
as controllers, indicators and/or switches, which provide
medical instrument data and/or patient status data to staff
members and which facilitate patient control of
environmental facilities within the patient's room, as will
be described below. Figs. 37a and 387b represent an
exemplary operational flow-chart of the interaction between
the patient station and the bedside equipment and between
the patient station and the CPU so as to facilitate
communication between the bedside equipment and the CPU.
Initially, the patient station monitors the inputs from the
external peripheral equipment (e. g., switches) to determine
if the equipment has been activated (steps 3710 and 3720).
If a switch or other peripheral equipment is activated, a
message frame associated with the activated switch will be
stored in the memory of patient station circuitry 3510,
shown in Fig. 35 (step 3722) and transferred to zone
controller 2420. If, on the other hand, a switch has not
been activated then the patient station will poll the
bedside equipment via serial port 3534 (shown in Fig. 35)
for status or message information and interpolate field
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parameters onto the received message (step 3724 and 3726).
The message frame is then stored in patient station memory
3516 (shown in Fig. 35) and remains therein until the
patient station 2416 is polled by the zone controller 2420
corresponding to the patient station (steps 3728, 3730 and
3732).
Once polled, the patient station transfers the
message frame to the S-RAM 2512 (shown in Fig. 25) of the
zone controller until the last byte of the frame has been
transferred (i.e., the F bit is set to logic 1) (steps 3734
and 3736). The zone controller then determines if the
message frame, received is an S-frame or an I-frame, and if
the message frame is an S-frame the zone controller
acknowledges the message frame and the patient station
returns to monitor the switch inputs (steps 3738 and 3740).
If the received message frame is an I-frame the frame is
transferred to the CPU which determines whether a response
to the transmitting station is required (steps 3742, 3744
and 3746). If no response is required the CPU stores the
received data and the patient station returns to monitor the
switch inputs, as shown. If, however, a response is
required a response message frame is sent to the zone
controller and stored in the S-RAM (step 3748). The zone
controller polls the patient station and if a received ready
(RR) command is received in return, the response message
frame is transferred to and stored in the patient station
(steps 3750 and 3752).
Once the response message frame is received the
patient station performs the task associated with the
information in the frame (step 3754). In addition to
sending a response message to the patient station, the CPU
may also be required to send a message frame to the nurse
control station to alert staff members of potential faults
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either through tone and visual indications similar to those
illustrated in Fig. 41 or by adding the information to the
problem report described above (step 3756).
Referring again to Fig. 32, in the preferred
embodiment, patient station 2416 is connected to patient
control unit 3210 via data link 3246. Patient control unit
3210 includes control buttons 3248 which facilitate patient
control of the environmental facilities within the patient's
room, via patient station 2416 and CPU 2412. Such
environmental facilities include, for example, the
television, radio, draperies and the room lighting.
Nurse call button 3250 is provided to enable the
patient to call the nurse control station or stations within
the group. As noted above, the communications between
stations is facilitated by CPU 2412 utilizing the
master/slave communication link described above.
Fig. 38 illustrates an exemplary operational flow
for the patient control unit 3210 in combination with
patient station 2416. Upon activation of nurse call button
3250 of patient control unit 3210 (shown in Fig. 32),
patient station 2416 receives the switch activation data via
data link 3246 and buffers 3530 (shown in Fig. 35).
Microprocessor 3512 then interpolates field data onto the
received message to form a message frame, as described
above, and stores the message frame in RAM 3518 (step 3810).
Once stored in memory, the nurse call data remains
therein until the patient station is polled by the zone
controller (step 3820). Once polled, the message frame is
then transferred to the zone controller and stored in the S-
~ (step 3830). The data remains in the S-RAM until the S-
RAM is polled by CPU 2412, upon which, the message frame is
then transferred to the CPU (step 3840).
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Reception of the message frame in the CPU causes
the CPU to begin the station task identified in the
INFORMATION field of the I-frame (step 3850), to determine
the message received from the patient station and provide an
appropriate response thereto (steps 3860 and 3870). For
this example, CPU 2412 is responding to the activation of
nurse call button 3250 of patient control unit 3210. The
initial response to the activation of the nurse control
button is to return a message frame to the patient station
to activate nurse call indicator 3222 of indicator assembly
3220 (shown in Fig. 32). In addition, the CPU prioritizes
the message frame utilizing the transition priority data of
the PATH field and then sends to the nurse control station
or stations connected in the group associated with the
patient station, a message frame including tone and display
data identifying the patient and the associated room number
(steps 3880 and 3890). At this point, the station task is
completed and the CPU returns to the listen task. Manual
reset of the patient station by a responding staff member
deactivates indicator 3222 and clears the message from the
nurse control station display.
Referring once again to Fig. 32, patient station
2416 may also be connected to staff presence switch 3254,
indicator assembly 3220, code blue switch 3234 and/or
emergency code switch 3232. In the configuration shown,
staff presence switch 3254 is connected to patient station
2416 via data link 3256 and when properly activated provides
patient station 2416 with a signal indicative of the type of
staff member present in the patient's room. Once activated,
a message frame (e.g., an I-frame) is transferred to the CPU
and an appropriate response is returned to that particular
patient station, in a manner described above.
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The responding frame from the CPU 2412 includes
information to cause the activation of an indicator in
indicator assembly 3220 which corresponds with the type of
staff member in the patient's room. To illustrate, if the
staff member entering the patient room is a registered nurse
(RN), that person would activate switch 3258 which in turn
would activate indicator 3224 of indicator assembly 3220 via
patient station 2416 and CPU 2412. If the staff member
entering the room is a licensed practical nurse (LPN), that
person would activate switch 3260 of staff presence switch
3254, which in turn would activate indicator 3226 of
indicator assembly 3220 via patient station 2416 ad CPU
2412. If, on the other hand, the staff member entering the
room is an aide, then that person would activate switch 3262
of staff presence switch 3254, which in turn would activate
indicator 3228 of indicator assembly 3220. When the staff
member leaves the patient's room, the particular staff
member switch is deactivated so as to deactivate indicator
assembly 3220.
In the preferred embodiment, indicator assembly
3220 is a four lamp light fixture (e. g., a dome lamp) having
colored lenses associated with each lamp. The fixture is
secured or otherwise positioned on the wall outside the
patient's room, preferably above the doorway, to allow staff
members in the hallway to simply look at each indicator
assembly and determine the type of staff member in a
particular patient's room, if any. Alternatively, the
indicator assembly may be any known type sufficient to
provide staff members with an indication as to the type of
staff member in a patient's room, for example, the indicator
may be a LCD display which identifies the type and the name
of the staff member in the patient's room in response to
information provided to the system by the above described
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staff locator system, described in more detail in commonly
assigned U.S. Application entitled "An Apparatus For
Automating Routine Communication in a Facility", naming John
Chaco as the inventor and filed August 3, 1992, which is a
continuation-in-part of copending U.S. Patent Application
Serial No. 07/559,196, filed on July 27, 1990, the
disclosure of which is incorporated herein by reference.
Code blue switch 3234 and emergency code switch
3232 are connected to patient station 2416 via data links
3264 and 3266, respectively, as shown in Fig. 32, and are
provided to allow staff members to initiate code blue or
emergency responses directly from the patient's room. As
noted above, code blue and/or emergency code procedures may
also be initiated from nurse control station 2414.
Initiation of the code blue response procedure at a patient
station 2416 will result in the following occurrences.
Initially the code blue data signal received from the code
blue switch is stored in the patient station memory as a
message frame, in a manner described above. The
microprocessor 3512 (shown in Fig. 35) in the patient
station 2416 then waits to be polled from the zone
controller 2420 before transferring the data to the zone
controller. Once polled by zone controller 2420 the message
frame is transmitted to the zone controller and stored in
the S-RAM 2512 until the S-RAM is polled by CPU 2412. Once
the message frame is received within the CPU the message
frame is prioritized and the station task associated with
the data within the INFORMATION field of the message frame
is initiated.
An example of a station task performed by the CPU
in response to the activation of a code blue switch will be
described below. Initially CPU 2412 determines the message
type received from zone controller 2420. Next the CPU
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performs whatever function is associated with the message,
in this example the message relates to the code blue
function. In response to the code blue function, the CPU
2412 sends to the particular patient station an I-frame
~ which includes data to cause activation of particular
peripheral equipment as well as devices within the patient
station 2416, e.g., a tone code and an indicator assembly
activation code. Next CPU 2412 determines which staff
station or stations 2418 and which nurse control station or
stations 2414 are grouped with the subject patient station
2416. Thereafter, CPU 2412 sends to each associated staff
station an I-frame including message data to display "code
blue" on staff station display 2422 of staff station 2418.
Next CPU 2412 sends a message to the ZIA 3022, shown in Fig.
30, to activate the proper indicator associated with the
patient station group in a manner similar to that described
above with reference to fail safe bus 3020.
The CPU 2412 then sends an I-frame to each nurse
control station grouped with the patient station to display
the room number and identity of the patient subject to the
code blue function, on the display of the nurse control
station. The CPU 2412 then sends to the nurse control
station an I-frame including appropriate control signals
associated with the patient station message. Once the above
steps are accomplished the station task is completed and the
CPU 2412 returns to the listen task.
The system of the present invention may also be
configured to monitor medical equipment being used to treat
the patient (i.e., bedside equipment). Such bedside
equipment may be connected to communication port 3534 (shown
in Fig. 35) of patient station 2416. In instances where the
serial data from the bedside equipment is not configured for
RS-485 protocol, serial data converter 2520 (shown in Fig.
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25) may be interconnected between serial port 3854 of
patient station 2416 and the serial port of the bedside
equipment. Typically, the serial port of the bedside
equipment is configured to operate with RS-232 protocol,
thus, serial data converter 2520 would be an RS-485 to RS-
232 converter which is known in the art.
Examples of the above described bedside equipment
are shown in Figs. 32. As shown, a hart rate monitor 3280
is connected to patient station 2416 via data link 3282,
which as noted above is operatively connected to nurse
control station 2414 via zone controller 2420 and CPU 2412.
The patient station (acting as a master station) polls heart
rate monitor 3280 (operating as a slave station) to verify
that the patients heart rate falls within the proper range
as determined by the monitor. The zone controller
periodically polls patient station 2416, as described above
for an S-frame or an I-frame message frame. Typically with
respect to this example, if no fault is detected the patient
station will respond to the polling of the zone controller
with an S-frame indicating proper operation of heart rate
monitor 3280. However, a fault detected in monitor 3280
will be stored in RAM 3518 of patient station circuitry 3510
(shown in Fig. 35) along with the appropriate field data in
the form of an I-frame, and the I-frame is transferred to
zone controller 2420 and CPU 2412 in a manner described
above. The CPU then analyzes the I-frame and an appropriate
alarm sequence is initiated to notify staff members at nurse
control station 2414 of the detected fault.
As another example, an intravenous (IV) pump 3284
is connected to patient station 2416 via data link 3286,
which as noted above is operatively connected to nurse
control station 2414, via zone controller 2420 and CPU 2412.
In this example, the IV pump is periodically monitored by
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patient station 2416 to ensure the flow rate of the pump is
appropriate. If a failure is detected, a message frame
including the error message is transferred to CPU 2412 in a
manner set forth above. The CPU the initiates an
appropriate alarm sequence, such as displaying a message on
the monitor of nurse control station 2414, that the IV
container is empty and needs to be changed. It should be
noted, that numerous other types of bedside equipment may be
monitored by the system of the present invention, including
respirators and heart monitors.
Transmitter 3290 is hardwired to the bedside
equipment, e.g., heart rate monitor 3280, and is provided to
enable central computer system 432 (shown in Fig. 4) to
determine what room or other area of the health care
facility the bedside equipment is located and to transmit
operation data generated by the bedside equipment, such as
status data or other data associated with the operation of
the equipment. In this configuration, transmitter 3290
transmits an identification signal and the operation data to
IR transceiver 424 which is in communication with central
computer 432 through network server 430, as shown in Fig. 4
and described above. Central computer 432 determines which
transceiver received the identification signal of the
bedside equipment and transfers the location data of the
e~ipment and the operation data to CPU 2412 via data link
2728 (shown in Fig. 27). Transmitter 3290 may be a radio
frequency transmitter operating at a frequency of
approximately 300 MHz, which are available from Dallas
Semiconductor, Inc.
STAFF STATION
Referring again to Fig. 24, staff station 2418 is
similar in design to patient station 2416. In the preferred
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embodiment, staff station 2418 may be configured, in the
initial system configuration setup, to operate in a "duty"
mode or a "staff" mode. In the "duty" mode staff station
2418 provides patient call indications on staff station
display 2422, as well as facilitating communication with
nurse control station 2414. In the "staff" mode staff
station 2418 facilitates communications with nurse control
station 2414.
Fig. 39 illustrates hardware configurations for
~0 the staff station circuitry 3910 installed within staff
station 2418. The staff station circuitry 3910 includes
microprocessor 3912, such as model 64180 manufactured by
Motorola operating at a frequency of 12.888 MHz. via crystal
3914, 96 Kbytes of memory 3916 (e.g., 64 Kbytes of flash ROM
~~ and 32 Kbytes of RAM) having stored programs, e.g., system
and application programs. In this exemplary configuration,
the data and address buses of the microprocessor are
connected to the memory, e.g., RAM 3910 and an EPROM 3920.
Memory decoder 3922 is utilized to select between RMA 3918
20 and EPROM 3920 in response to a particular address on the
address bus. The address bus is also connected to a pair of
latches 3924 and 3926 which interface the microprocessor to
status indicators, the fail safe bus (FSB), the audio
control circuitry, and to switches and other peripheral
equipment connected to the staff station, as shown. In
addition, I/O decoder 3928 is utilized to select between
either latch in response to a particular address on the
address bus. Incoming signals from the above noted
peripheral equipment are received by buffer 3930 and then
transferred to the data-bus upon being enabled by I/O
decoder 3928.
Utilizing the preferred microprocessor (i.e., the
Motorola 64180), serial communication between the zone
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controller and the microprocessor may be accomplished
through asynchronous serial communication port 3932 which
is, preferably, configured to RS-485 protocol utilizing RS-
485 driver/receiver (RS-485 D/R) 3934 as shown.
Fig. 40 illustrates hardware configurations for
the audio portion 4010 of staff station 2418. As shown,
audio pair 4012 from an equipment panel (e. g., audio matrix
2510 shown in Fig. 25) is connected to the front end of
audio controller 4014. Preferably, the front end of audio
~0 controller 4014 includes a coupled 600 ohm balanced
transformer 4016 which isolates the internal audio circuitry
of staff station 2418 from the external audio circuits.
Depending upon whether the audio signal is being received or
transmitted, the back end of audio controller 4014 directs
the audio signal to staff station speaker 4018 or directs
the audio signal from microphone 4020 to audio matrix 2510
via audio controller 4014.
Preferably, audio controller 4014 is a 34118 audio
controller manufactured by Motorola. Audio input signals
from audio matrix 2510 which pass through the audio
controller are directed to staff station speaker 4018 via
amplifier 4022. Audio generated by the staff station via
microphone 4020 is selectively transferred through audio
controller 4014 onto the audio pair as shown. Mute switch
4024 may be provided to allow a staff member to manually
short out the microphone so as to prevent audio signals from
being generated at the patient station.
SYSTEM FUNCTIONS
The patent care and communication system of the
present invention may be programmed to perform numerous
operations associated with patient care and communications
within a hospital or other health care facility. The
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1 following functions are exemplary of the numerous types of
features and the functional flow (or data exchange) between
the different stations, the CPU and the zone controller
utilize the above described preferred master/slave
communication link.
a. Call priority
Message frames usually in the form of an I-frame
originated by a nurse control station, a patient station
and/or a staff station are interpreted by CPU 2412 and
assigned a priority level based upon the type of message
frame received (i.e., the DTYPE field of the INFORMATION
field contains the message type which corresponds to the
priority level that will be assigned to the frame). In
addition, the message associated with the TEXT field of the
message frame is displayed on nurse control station display
3272 of a nurse control station 2414 in order of priority
level. The priority levels are preprogrammed during the
initial set-up of the system configuration, but may be
altered by staff members at nurse control station 2414 via
keyboard 3236 or direct~select keys 3274 (shown in Fig. 32).
The highest priority call will be displayed first and other
calls will follow in descending order according to the
priority level.
Preferably, each call originated has specific
audible and visual signaling based on the call priority
level which are distributed to the necessary nurse control
stations, zone indictor assembly, patient stations and/or
staff stations via CPU 2412 and their respective zone
controller. Figs. 41-43 represent tables illustrating
exemplary embodiments of call priority levels, their
associated visual and tone indications which are generated
at either the nurse control station, the patient station
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and/or the staff station. Fig. 41 illustrates the preferred
visual display which appear on nurse control station display
3272 and the tones generated at speaker 3238 (shown in Fig.
32) in response to the various priority levels. For
example, in response to the activation of code blue switch
3234 (shown in Fig. 32) CPU 2412 will transmit to nurse
control station 2414 a message frame instructing the nurse
control station to display on the nurse control station
display 3272 a flashing arrow directed at a direct select
key 3274 to indicate which key will enable the staff member
to connect the audio of the nurse control station to the
audio of the patient station and respond to the call. The
arrow will flash at a rate of approximately 120 pulses per
minute (PPM). In addition, the room number and bed number
1~ associated with the patient station to which the code blue
switch is connected and the "CODE BLUE" message will be
displayed on nurse control station display 3272. An audible
tone at the rate of 120 PPM will also be generated at
speaker 3238 of nurse control station 2414.
The preferred response at patient station 2416,
shown in Fig. 42, to the activation of the code blue switch
will be to pulse a station call and bed call placement LED
indicators (not shown), which may be positioned on the front
panel of patient station 2416, at a rate of 120 PPM, and to
?5
pulse a code blue indicator of the corresponding group
indicator assembly 3024 via ZIA 3022 (shown in Fig. 30) at a
rate of 120 PPM.
The preferred response at staff station 2418,
shown in Fig. 43, to the activation of the code blue switch
will be to pulse an incoming call LED indicator which may be
positioned on the front panel of staff station 2418, at a
rate of 120 PPM, to display on staff station display 2422
(shown in Fig. 24) the room and bed number associated with
3~
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the patent station to which code blue switch 3234 is
connected and to display the "CODE BLUE" message; to pulse a
blue indicator of the corresponding group indicator assembly
3024 via ZIA 3022, at a rate of 120 PPM; and to generate an
audible tone at the rate of 120 PPM at speaker 4018 of staff
station 2418 (shown in Fig. 24).
b. Nurse Follow
The nurse follow feature allows a staff member to
selectively direct incoming calls to a particular nurse
control station to selected patient stations and/or staff
stations. To illustrate, this feature may allow the staff
member to program the nurse control station to distribute
incoming calls to a single patient station, to patent
stations where particular staff members have activated
respective staff presence switches (e. g., switch 3254, shown
in Fig. 32) and/or to all patient or staff stations assigned
to the group associated with the particular nurse control
station. Thus, when a staff member is required to leave the
area of a nurse control station, incoming calls to the nurse
control station can be routed to locations where appropriate
staff members can respond to the call.
In operation, a staff member attending nurse
control station 2414 may utilize direct select keys 3274
(show in Fig. 32) in response to menu driven prompts to
configure the system to operate in the nurse follow mode.
In the nurse follow mode, calls which are directed to the
nurse control station 2414 via CPU 2412 and corresponding
zone controllers 2420 will automatically be routed to the
station or stations selected by the staff members or to
stations in locations where that staff member or other staff
members are determined to be present by staff locator system
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2428 (shown in Fig. 27 and described above with reference to
Figs. 1 through 23).
For example, if the staff member selects the nurse
_ follow feature which routes incoming calls to patient
J
stations where the RN switch 3258 of staff presence switch
3254 (shown in Fig. 32) has been activated, CPU 2412 will
direct the incoming call to the nurse control station to any
room in the group where switch 3258 of staff presence switch
3254 has been activated.
As another example, CPU 2412 of the patient care
and communication system interacts with central computer
system 432 of staff locator system 2428, shown in Figs. 4
and 27. In this configuration, the identification badges
1111 are in communication with central computer system 432
in a manner described above with particular reference to
Figs. 4 and 7c. The identification badge 1111, which is
worn by the staff member, continually transmits the
identification signal (of the staff member) and central
computer system 432 continually monitors the identification
signal to update the location of the badge (and the staff
member). The location~information of the staff member is
transferred to CPU 2412 via data link 2726 (shown in Fig.
27) which may be any known type of communication link
utilized to facilitate communication between computer
systems. Therefore, when a call is directed to a nurse
control station 2414 programmed to operate in the nurse
follow mode, CPU 2412 will route the incoming call to a
station (either 2416 or 2418) positioned nearest the
detected location of the staff member. In an alternative
e~odiment, a staff member attending the nurse control
station may want to route incoming calls to locations of
other staff members. In this embodiment, the nurse control
station can be programmed in the nurse follow mode to route
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the incoming calls intended for nurse control station 2414,
to stations where the other staff members have been detected
by the staff locator system.
J
c. Voice Paging
The voice page feature allows staff members to
communicate to selected patient and/or staff stations from
the nurse control station. To illustrate, this feature
allows a staff member to communicate to all staff members
who have activated staff presence switches associated with
the nurse control station (i.e., within the same group) and
all staff members in areas where staff stations are located.
Fig. 44 illustrates an exemplary operational flow for the
voice paging feature of the present invention. Initially,
~~ the staff member desiring to page all staff members within
the assigned group, programs nurse control station 2414 via
direct select keys 3274 (shown in Fig. 32) which activate
menu driven functions (step 4410). The menu driven
instructions from the nurse control station are then
transferred to the CPU via zone controller 2420 in a manner
described above (step 4420). The CPU analyzes the
instructions, e.g., determines the identification of the
patient and/or staff stations and their associated zone
controllers and the CPU performs the function associated
2~ with the received message frame (step 4430, 4440 and 4450).
Thereafter, the CPU causes the audio connection between each
station and the nurse control station and notifies the
paging staff member to begin talking (steps 4460 and 4470).
Alternatively, the voice paging feature may
utilize staff locator system 2428, shown in Figs. 4 and 27
to determine the location of a staff member or members so
that the staff member attending nurse control station 2414
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may communicate with the patient and/or staff stations
nearest to each staff member or members being paged.
_ d. Room Monitoring
J
The room monitoring feature allows staff members
attending a nurse control station 2414 to activate the audio
system of either a selected number of patient stations 2416
or to manually step or automatically scan through each
patient station 2416 in each room associated with the
~0 station grouping, described above, in a predetermined order
for a predetermined period of time so as to activate
microphone 3520 of patient station 2416, enabling staff
members to listen for sounds of distress or other
uncharacteristic noises so as to check on the well being of
a patient or patients. Preferably, the predetermined order
for monitoring rooms is from the lowest room number to the
highest and the predetermined period of time is
approximately ten seconds. In operation, the staff member
attending nurse control station 2414 configures the system
for automatic room monitoring by depressing direct select
keys 3274 or nurse control station display 3272 in response
to menu driven prompts. Once configured for automatic
monitoring, CPU 2412 sends a message frame to each patient
station in the above noted order to activate microphone 3620
(shown in Fig. 36) of audio circuitry 3610, via audio
controller 3614, for a period of ten seconds to allow the
attending staff member to listen for distress noises and
other uncharacteristic noises.
Diagnostics
The system of the present invention also provides
diagnostic features which continuously monitor system
components. As noted above, system faults are communicated
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1 to the nurse control Station and/or the staff station and
added to the problem report. Hard and/or soft copies of the
problem report may be obtained from printer 2724 and/or
external computer 2722 (shown in Fig. 27) or the problem
report may be displayed on nurse control station display
3272 when the "problem reports" feature is selected by
direct select keys 3274 shown in Fig. 32.
In addition, the operation of selected periphery
devices in the patient's room are continuously monitored and
any failures are brought to the attention of the staff
member at a nurse control station within the group. For
example, the wiring to code blue switch 3234, the smoke
alarm and/or the nurse call button 3250 on patient control
unit 3210 may be monitored for damaged to the wires between
such periphery devices and patient station 2416.
Fig. 45 shows the hardware components for patient
control until 3210 which is connected to patient station
2416. Preferably, the wiring is tested by microprocessor
3512 (shown in Fig. 35) activated signals in combination
with the wire test circuitry 4510. Wire test circuit 4510
includes resistor 4512 and field effect transistor (FET)
4514 which are connected between call wire 4516 and nurse
call wire 4518, as shown. In this configuration,
microprocessor circuitry 3510 of patient station 2416, shown
in Fig. 35, periodically turns on FET 4514 via call wire
4516 therefore completing the ground path connecting call
wire 4516 and nurse call wire 4518. Microprocessor 3512
then interrogates nurse call wire 4518 via buffer 3530
(shown in Fig. 35) in response to microprocessor driven
instructions, so as to perform a continuity check of the
nurse call feature of patient control unit 3210.
Preferably, the period between each wire test is two
seconds. Wire test circuit 4510 may be utilized to perform
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WO 94/22098 ,2 15 l 4 0 5 pCT~S94/02114
-122-
1 wire tests between any periphery equipment and the processor
associated with the station to which the peripheral
equipment is connected. In the event the continuity check
fails, a failure alarm sequence is initiated to notify staff
members of the wire failure and which wire in which
periphery device has failed.
The patient care and communication system of the
present invention also includes external diagnostic device
2570 connected to serial data converter 2520, as shown in
Fig. 25. Preferably, external diagnostic device 2570 is a
modem provided to facilitate external diagnostics of the
patient care and communication system of the present
invention, via converter 2520 and zone controller 2560.
External diagnostic device 2570 allows a technician or other
service personnel to remotely verify and update the
configuration of the system in a manner similar to that
performed by staff members attending a nurse control
station. In addition, the external diagnostic device 2570
allows the technician or other service personnel to view the
system problem report which, as noted above, includes
information as to which~stations or equipment are not
operational.
It will be understood that various modifications
can be made to the embodiments of the present invention
herein disclosed without departing from the spirit and scope
thereof. For example, various system configurations are
contemplated, as well as various types of protocols utilized
to communicate between the numerous stations utilized within
the system of the present invention. In addition, numerous
functions aside from those described herein may be
programmed and performed in the system of the present
invention. Therefore, the above description should not be
construed as limiting the invention but merely as
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d0 94/22098 215 7 ~ 0 ~ PCT/US94/02114
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1
exemplifications of preferred embodiments thereof. Those
skilled in the art will envision other modifications within
the scope and spirit of the present invention as defined by
the claims appended hereto.
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SUBSTITUTE SHEET (RULE 26)
